Claim, Kahle, KathyCLAIM AGAINST THE CITY OF DUBUQUE
This written report constitutes your claim against the City of
Dubuque, Iowa. You should complete this form in full and attach
any additional information that supports your claim.
The Claim must be filed with the City Clerk at City Hall, 50
West 13th Street, Dubuque, Iowa 52001-4864. It will then be
referred by the City Council to the appropriate Department for
· nvestigation. Once that investigation is completed, a report and
reco~endation will be submitted to the City Council. You will be
provided with a copy of that report and recommendation.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL.
NO EMPLOYEE OF THE CITY OF DUBUQUE F~AS THE AD'£~ORITY TO MAKE ANY
REPRESE.,~!TATION TO YOLT _~ TO W~_ET~ER YO~P. C!=.~_IM WiLL OR WILL ~0T
PAID.
1. Name of Claimant: Kathy Kahle
2. Address: 1505 Parkway St.
3. Telephone No. 563 583 8470
4. Date of Inicident: Summer through fall 2000
5. Time of Incident: ~ '~
(O~ve full details upon which 7ou Base your claim, if a Cit~
employee was involved, ~ive the emplgyee's name. )
6. Location: 1505 Parkway
7. Describe: Horsefield Construction was tearing up and rebuilding Parkway
St. during this time and this involved a lot of pounding with machinery that shook our home enough to knock
a glass off the rack breaking it and another dish below.
11. Was anyone injured?
injuries.).
(If so, give name, address and extent of
12.
Was any d~m~e
and the extent
describe basis
done to property? (If so, describe property
of damage. Attach escimates of damages or
for ascertaining extent of damage.)
do
14. Have you been compensated for any part or all of your claim by
any insurance company? (If so, give name and address of
insuranc~c,ompany and a~ount pa'd
15. What amount do you claim from the City of Dubuque?
The amount to cover fixing the crack in the ceiling and roof, replacing the mortar
in bricks on front steps, the dishes and reimbursing Peking Ins. $400.00
water damage in sun room.
16. ~'~ ~O yO~ clal~he City of DLLbuque
17. any c e
result of this inci~
If yes, give name and address: I,~]~ --
· ~. ~,~ ~ne ~swer ~o ~ues~mon ~ is ye~, nave you receive~ any,
pa~ent from that source, ~d if so, in w~t ~o~t? ~ ~
Dated at Dubuque, Iowa this 11 day of May, 2001.
/s/ Kathy Kahle
(Print/ N~me)
(Revised January, 2000)
PROPERTY ESTIMATE ~oge ~o:
/
INSURED
CLA~ #,~?~.~,,v ~oucY #
.~ ,¢ ~.~.0 ~¢'/"Z. I ) ,, (if Applicable) Material Labor
ItemNo~-/~-z,~..~ ~ Work ,equated ~ ~ ~uantit, Unit Price Cast Cast Deprociatio, Total
Te~S ~.
(USE THIS SPACE FOR DIAGRAM)
261 (Rev. 12-95)