Claim, Harris, Julie G.CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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 W. 13th St., Dubuque, IA 52001. It will then be referred by the City Council to the appropriate department for investigation. Once that investigation is completed, a report and recommendation 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 NOT BE PAID.
1. Name of Claimant: Julie G. Harris
2. Address: 213 Jule Ave (East Dbq.?)
3. Telephone Number: 815 747 6809
4. Date of Incident: July 12, 2001
5. Time of Incident: Somewhere between ^:30 A.M. & 4:00 P.M.
6. Location of Incident (Be specific): Parking Garage on Iowa St., 2nd level, Stall #200
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. If a City employee was involved, give the employee's name.)
The lines in the parking ramp were being painted and white paint sprayed upon on to my car on the sides, hood, and roof.
8. What were weather conditions like? Sunny and Warm
9. Give name and address of any witnesses: None that I am aware of
10. Did police investigate? (If so, give names of officers.)
No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of damages or describe basis for ascertaining extent of damage.)
None
13. What other damages do you claim, if any?
None
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.)
Rockford Mutual - not sure of amount, all bills went straight to insurance company.
15. What amount do you claim from the City of Dubuque?
The amount it costs to remove paint from car and having back to condition it was in before incident.
16. Why do you claim the City of Dubuque is responsible?
Because the car is brand new. We brought it home on Monday night. Thursday I pulled into ramp at
6:30 A.M. and the lines weren't painted. When I left at 4 P.M. they were freshly
painted.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 17th day of July, 2001. , 20 .
/s/ Julie Harris (Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM A~AINST 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 completed, a report and
recommendation will be submitted to the City Council. You will be
pr_O~&~ed with a copy of that report and recommendation.
THE FINAL DECISION ON ALL CLAII~g IS MADE BY THE cITY COUNCIL.
NO'- ~MPLOYEE OF THE CITY OF DUBUQUE HAS T~E AOw~ORITY TO MAKE ANY
REPRESENTATION TO YOU AS TO WtIET~R YOUR CLAIM WILL O1{ WILL NOT BE
7. DESCRIBE ACCIDENT OR O¢CIIRRENCE THAT CAUSED INjo~ OR DAHA~Eo
(~ive full details Upon which you base your Ula~, ~f a City
employee was illvolved, ~ive the e~Pl0Yee,s n~e.)
8. ~at were wea~er conditions like? ~ ~/~.
10. ~ poliue investigate? (if so, give n~es of of~
12. Was any damage done to property? (If so, describe property
and the extent of dmmage. Attach estimates of d~ages 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 ail of your claim by
· any insurance company? (If so, give name and address of
insurance company and amount paid. )
15.
16.
17.
If. yes, give name and address:
18.
I'f the answer to 'Question 17 is yes, have .you received .any
payment frem that Source, a~d. if s0, in. what a~ount?
Dated at Dubuque, Iowa, this
2001.
(Revised Ja~uaz~, 2000)
(Print Name)