Claim, Midwest Cable Co.CLAIM 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
investigation. Once that investigation is co=~leted, a report and
recomx~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 HAS THE AUTHORITY TO MAKE ANY
REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL .~OT BE
PAID.
1. ~e of Claimant: ~i~b~+
3. Telephone Number:
4. Date of Incident: ~ ~--
5. Time of Incident.-
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE.
(~ive full details upon which you base your claim, if a City
employee was involved, give the employee's name.)
~o What were weather conditions like? ~ \'~_~,--
10.
Did police investigate? (If so, give names of officers.
11.
Was a~yone injured?
injuries. )
(If so, give name, address and extent of
(%O
12. Was any d~mage done to property? (If so, describe property
and the extent of damage. Attach estimates of damages or
describe basis for ascertaining extent of damage.)
13.
What other damages do you claim, if any?
14. Have you been compensated for any part or all of your claim by
any insurance company? (If so, give name and address of
insurance company and amount paid.)
15. What amount do you claim from the City of DuJ0uque?
16. Why do you claim the City of Dubuque is responsible?
17.
Have you made any claim against anyone else for damages as a
result of this incident? ~c%
If yes, give name and address:
If the answer to Question 17 is yes, have you received.any
payment from that source, and if so, mn what amount?
Dated at Dubuque, Iowa, this
20 O (
(Signature)
(Print Name)
(Revised Januars,, 2000)
GROVE
50246
TSCHIGGFRIE
EXCAYATI G CO.
425 JUl YEN DUBUQLIE DRIVE
P.O. DRIVE BOX 3280
DUBUQU~ IOWA 52004
'(319J 557-7450
0000
8?5 DATE OF INVOICE:04/30/200:j' INVOICE NO.:
M;~ '~' )4/:16/01 TARGIET., SAW 65 HP ~.~/~"aYE~5'O00 380
' HR ~'' ).4/&7/0:1. CAT 436 BACKI~3~E:. RAH.t/t~l!/mO00
* '~'" *" .... HR '~ ')4/18/01 BOBCAT SKID L. OADIER ~ '. 80,000 360,0(
~:~3S-,88 :::TN ; )4/18/01- F:I:LL' L-Z~IE ~ 4,750
_.;_, -." HR: w )4/2.8/01 CAT 436 BACKHOE S6.()~O 2~
~%~'-:%~:50.~* 'tqR * )4/18/01 I..?BORER, ,~ 42,000 105.0(
,. * ~:~3:¢ ¢''~ ..... :~:. .... ~=*~ CY }4/:L8/()]. CONCRETE~%~%~ 85 000. 22 2~
~-t:~':?:a,¢;x?:~:.¢2.50 CY )4/].8/0:1. CON?~ETI~. . 85,000 212,5(
~ ~(~::::~.,:OO, HR w ~4/I9/02 BOBCAT SKIO I...C}6t~ER~. ac {~0,000 400,0(
RESPONSIBILITY FOR DAMAGE WHERE DELIVERY IS MADE'IN'SIDE7. CURB.
ACCOUNTS DUE lOTH OF MONTH FOLLOWING DATE 01: INVOICE?i/:'
d) LATE PAYMENT CHARGE W LL BE'ADDED TO ACCOUNTS 30 DAYS PAST,DUE,
~ IOWA--"~-~
Cai er's Na
Con~ Pem~ ~ Conta~ Telephon~: ~ I qq~
C~ orTownship
se~~;: - ~, QuaderSection NW NE SW SE
Ne~st lntemection
Type of Wo~:
El Trenching ~:~ Boring O Plowing ~ackhoe
O Other ~psting O~Yes J~No
Who Ls work being done for.,~'~, ~'~.~¢/ /~F,)~
Bast time to call bastc /~gO~ O PM O Affer 5:00 p.m.
Work Locetion (where on properiy):~
INFORMATION WE WILL GIVE YOU:
UTILITIES WE ARE GOUTACTING (Check Below):
Cable
O er ote :
ONE CALL ~.
\
Company ~ame ~.~.t~ I.~.~'~
Com~ ~ers~ ~ Contact
S~ Date:)q~¢ nme~,TffDuratioa of Project
Se~on~: Ou~erSection N~ NE SW SE
Neare~ I~ersec~
Q Trenching ~Boring Q Plowing
Other ~l~tmg Y~s No
~o is work being done for: ~ ~
Best hme to ~ll back: ~ ~1 ~.m.
Work b~tion (where on prope~: ~ ~ ~
INFORMATION WE WILL GIVE YOU:
Locate Request ~.
UTIUTIES WE ARE CONTACTING (Check Below):
Fiber ' ' Cable
Gas /Elecl~ic~ Phonel Water ISewerl TV
Optic
otherNotas:
Fiber
Optic
June 15 2001
MIDWEST CABLE
[ N C O R P O R A - E D
CiTY CLERK AT CiTY HALL
50 WEST 13TH STREET
DUBUQUE, IOWA 52001-4864
To whom it may concern
J have enclosed information oertaining to the sanitation sewer hit on
West 16th St. and Bluff St. The city's bill for this is $ 2304.85.
' have broke down the bill to snow wny. Tschiggfrie had to come out to
remove all debris from the hole so they could get in and dig around the
sewer then they had to bring in lime for the hole and finish backfilling and
tamping. None of this would have been necessary if it were not damaged
and ali dirt and material could have been replaced and tamped.
Jane Smith came out from the city and saw that there were no locates
down. Gus from the sanitation department later told me that they didn't
know we were going to be digging that deep and the city Iocator said the
prints showed it was in the middle of Bluff St. I also video taped the site
showing no locates and have included copies of the locate tickets and
instructions. If this is not resotved immediately i will be forced to have other
agencies help with this matter. I also have other areas video taped showing
where everyone but the sanitation department had located. A prime
example of this is at the corner of Kerper Bird and East 16th St. As there is a
forrest main on that corner and the city has no clue as to it's exact location.
My instructions for this was to BE CAREFUL[! This incident would never have
happened had it been located. We cannot be held accountable for the
city's negligence. This claim could have been sent back sooner if the city
would have sent me the form when t first requested it. I hope this
information will help clear the matter up and the importance of locating all
services when they are requested.
Sincerely,
Robin Tedrick ~
3612LAK~NS GROVE' STANHOPE, IA 50246
515-826-4464 FAX: 515-826-5464
800-952-5950
SPECIALISTS JN ALL PHASES OF FIBER
AERIAL ' SPLICING ~' PLOWING · TRENCHING '~ DIRECTIONAL BORING