Claim - WinterSmith, Norma J.
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: Norma J. WinterSmith
2. Address: 1676 Jackson ST., Dubuque, IA 52001
3. Telephone Number: 319 582 0987
4. Date of Incident: Over the past 2 years - damage to roof & siding
5. Time of Incident: Because of tree branch not being trimmed
6. Location of Incident (Be specific): 1676 Jackson
ST. - left corner of brown roof & white siding of my home
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.)
I phoned City tree trimming two years ago - twice and also talked to men direction who were removing trees on same block. I phoned again
this spring - each time explaining my concern for roof and siding.
8. What were weather conditions like?
9. Give name and address of any witnesses: None
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.)
House at 1676 Jackson has brown shingles and white siding that was damaged by a tree in the parking area ahead of
apt. house at 1698 Jackson ST., Dub. IA
13. What other damages do you claim, if any? None at this time although more damage to house was done to siding by work being done on apt. bldg. at 1698 Jackson.
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.)
No
15. What amount do you claim from the City of Dubuque?
Only want the damage to roof and white siding repaired, please.
16. Why do you claim the City of Dubuque is responsible?
Because I made the city aware repeatedly of my problem and the resonse took
so long. I was told they had a back log of work to do.
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?
No payment of any kind.
Dated at Dubuque, Iowa this 9th day of , 20 .September
2001.
/s/ Norma J. WinterSmith
Come see my house - please.
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa.
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.
3. Telephone Number: (7/~
6. Location of Incident (Be specifIc): ~2~
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
employ~'s name.) ~ . ~.
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.)
13. What other damages do you claim, if any?.~_.
'/ y ? .
14. Rave yourbeen compensate~ 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 amountdo you claim~from the City of, Dubuque?~zz~ ~,~ ~ ~,~_..
16. Whydo you claim the City Of'Dubuque is respgnsib!e?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, givf~ name and address.)
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~Dubu_.que, Iowa this
~ day°f _~~ ,20 ~/.
~/2 - (Signature)
(Print Name)
(Rev. 1/00 & 7/01)