Claim Larson KellyCLAIM 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: Kelly Larson
2. Address: 4962 twilight Drive Dubuque Ia 52001
3. Telephone Number: 319-557-1758
4. Date of Incident: 12/14/00
5. Time of Incident:between 1:00 & 5:00 PM
6. Location of Incident (Be specific):
Parking Stall #11 along south side of city hall
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.)
car parked in city stall at city hall. moticed damage next a.m. because blinker not working on driver home 12/14. Returned to work
12/15, noticed icicles on building, Had complained of problem withmy spot last winter & thought problem was solved.
8. What were weather conditions like? Cod & Vvercast
9. Give name and address of any witnesses:
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.)
yes, dents to hood of car at front right corner, broken blinker light, cracked headlight & cracked frame surrounding headlights.
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.) no
15. What amount do you claim from the City of Dubuque? Enitre cost of repair.
16. Why do you claim the City of Dubuque is responsible? the icicle appeared to for at break behind gutter complained to
building services & ops & maint
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 15th day of December , 2001 .
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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 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 T~ AUTHORITY TO MAKE ANY
REPRESENTATION TO YOU AS TO W~MTHER YOUR CLAIM WILL OR WILL NOT BE
PAID.
2 Addreee: '- . ,o
¢
7. DESCaIBE-~CCIDE~T Oa OCCU~ENcE'TaAT 'cAusED INouaY Oa DAMAGE.
(~ive: full details upo= which you base your claim. If a City
employee was invOlved, give the employee, s n~me. )
9. ~ive n~e ~d address of ~y witnesses.
10. Did police investigate? (If so, give n~es of officers.)
11.
Was ~yone injured? (If so, give name, address and extent of
injuries.)
12. Was any ~m-ge done to property? (If so, describe property
and the extent of damage. Attach estimates o£ damages or
describe basis for ascertaining extent of damage.)
13. What other ~m~ges do you claim, if any?
lA.
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 Dubuque?
Rave.. you made-a~.y .claim against anyone else for d===gea, as a
result of ~s ~cxd~t?fl_~
18. If
payment fr~m that'Source, and if so, in. what amount?
Dated at Du~u~e, Iowa, this ~ day of
2000
( Revise~ Januax-yo
( Prin~ Name)
CITY OF DUBUQUE, IOWA
MEMORANDUM
January 18, 2001
TO: Barry Lindahl
FROM: Kelly Larson ¢
SUBJECT: Ice Formation on City Hall
I think Bill mentioned to you.the damage to my car, which is the subject of the attached
claim. I wanted to send a short note to suggest that, regardless of the response to my
claim, the City evaluate whether the problem with icicle formation can be remedied.
I am concerned that someone could be injured by the icicles that are forming. I realize
that people do not tend to walk along that side of City Hall, reducing that possibility.
However, had I been cleaning snow off of the hood and headlights of my car when the ice
fell, I certainly would have been injured.
It appears from the ground that the ice is not flowing over the roof and jamming up the
gutters - a problem we've heard much about this year. Rather, the ice seems to be
forming behind the gutter, rendering the gutters virtually useless. If the formation of ice
is a natural phenomenon we cannot control, that is one thing. But I do think we should
investigate whether or not the problem can be alleviated, at least to some degree.
Thanks for considering the problem - and watch where you park that fine vehicle of
yours!
Q AISO bl
BEYER AUTO & COLLISION
, EPWORTH, IOWA 52045
Business Phone (319) 876-3613 Other Ins.
~ H~9) 556-7980
Name ~.~ License No. Amt. Deduct
Address j~)~ ~ M Phone W Phone
Year rim C~e J Serial No. Mileage Date
- R~- Re- Description Of Repairs And Replacements Labor Parts and Sublet
Pla~ Pair Hours Materials Net Items
~e a~ is a~ estimate ba~d on o~r i~5pection and does not [ Totals
the work has ~n o~ned up. Oc~sionally after the work has
~a~, worn or damag~ ~as are di~vered which are not Parts $ ~ss To
evident on the first ins~ion. ~u~ of this the a~ve prices ~
~e ~ g~rant~, and are for imm~iate acceptance only. Sub]~ and Net Items / ~
~G - him Pe~rmance U~fime Guaran~e Sub-To, al ~/ 7~
Tax ~
NAME
ADDRE~ _
ROSS BODY SHOP
FARLEY, IOWA 52046
(319) 744-3545
DATE
_ PHONE.
INSURED BY ADJUSTER
MATE TO REPAIR YOUR ~ ~'~
__PHONE__
su~ Tot~
Tax
Materials
Total
BY
AUTHORIZATION FOR REPAIRS
SIGN~ DATE