Claim by Lois K. Pearce,~~G~ ~~-~ ~ ~~:~~~~ G~~~
CLAIM AGAINST THE CITY OF DUBUCFUE, 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.
Name of Claimant: ~0~5 ~i ~~~~ rc
2. Address: i 5
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3. Telephone Number: S6~ --5~':3 -~6~~
4. Date of Incident: ~ ~~ ~~}~ /J~r `~ -~ ~ ~ ~
5. Time of Incident: ~~~u~~~~? /~~ .~ 3n ter- rr,. ~'~ d /~_ vo ~ m-
6. Location of Incident (Be specific): Se-~ ~~~r~h~~
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.)
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8. What were weather conditions like? S~ ~ ~~~ Q ~ ~~~d
9. Give name and address of any witnesses: ~ ~ ~ ~~~ ache
10. Did police investigate? (If so, give names of officers.)
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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.)
~~~ c2 ~~ ached
13. What other damages do you claim, if any? ~~ ~ ~~~a ch ~ ~ - /G o~I ~
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.)
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15. What amount do you claim from the C~i/ty of Dubuque?
16. Why do you clacci~~m the City of Dubuque is responsible?
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
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Dated at Dubuque., Iowa this ~ ~iday of /tX~!C~~~~ 20~.
~Ois fj . l G~~r~~ (Print Name)
(Rev. 1 /00 & 7/01)
cY~ /~ ---~~'f~'-~- (Signature)
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ATTACHMENT TO CLAIM AGAINST CITY OF DUBUQUE, IOWA
1. Name of Claimant:
2. Address:
3. Phone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident:
7. Describe Incident:
Lois K. Pearce
1560 Douglas Street, Dubuque, IA 52001
563-583-6634
Tuesday, December 4, 2007
Between 10:30 and 11:00 a.m.
On Hill Street, about mid way between W. 3`d and W. 5~`
Streets
I was driving east on W. 3`d and turned left on to Hill
Street. Snow had been plowed up on both sides of Hill Street from
the previous day's snowfall. Cars were sporadically parked on the
curbside snow as best they could.
As I was driving down Hill Street (north), a City snowplow
with a "V" blade was going up Hill Street (south). The blade on
the plow was a good 3 feet over the yellow line in my lane. I
pulled to the right as far as possible to avoid the plow, and passed
by 1 or 2 cars when I heard a loud crack. My first reaction was
that someone threw an ice ball and cracked a window in my car. I
pulled west into the alley before reaching W. S~' and realized my
right mirror was badly damaged. I drove back up Hill St. to see
what I must have hit or what had caused the damage.
When I had driven down Hill St. I saw a lady with 2 little
children on the west side of the street waiting to cross the street to
get into a car. When I drove back up Hill Street, I saw that same
lady outside a car picking up pieces of my mirror, which were
scattered in the snow by the street. She had put the two small
children in the car.
I drove back up to W. 3`d to turn around and then drove
back down Hill Street, pulling into the curb some distance ahead of
the lady's car where there was room to park. She carne to my
window and said she heard the loud noise and said I had hit her left
mirror, but that no damage had been done. I questioned her
because I felt sure she must have gotten at least a scratch. So I
walked back to her car and looked her mirror over carefully, and as
she had stated, the only thing that happened was that her minor
had flipped as it is made to do, but no damage. I offered to give
her my name, but she insisted it was not necessary. I asked for her
name but she hesitated, saying I should have a good day and don't
be concerned. Finally, she stated her name was Brandy Dunlap (?)
but did not state where she lived. She got in the car with the
children and said not to think further about it and have a wonderful
holiday.
I drove my car to Turpin Dodge and asked them to make
arrangements to repair it. My car is a 2007 Dodge Caravan with
about 2900 miles on it. A copy of the service invoice in the
amount of $150.23 is attached.
8. Weather Conditions: Clear visibility following snow the previous day and night.
Snow was plowed toward curb on both sides of Hill Street.
9. Witnesses: None known
10. Police Investigate: No
11. Anyone Injured: No
12. Property Damage: None known other than the right mirror on my van
13. Other Damages Claimed: None
14. Any Compensation by Insurance Company: None
15. Amount Claimed From City: $150.23 (See copy of Service Invoice attached)
16. Why Claimant Feels City is Responsible: I believe the incident occurred
because the blade of the City snowplow was into my driving lane by at least 3
feet requiring me to pull to my right. Consequently, I swiped the mirror on one
of the cars that were parked curbside. Fortunately, only my mirror was damaged.
17. Claim Against Anyone Else: No
18, Any Payment Received: N/A
Dated at Dubuque, Iowa, this 10~' day of December 2007.
~--i'S ~'~ ~\ , ~~~" ~~~ ~- (Signature)
Lois K. Pearce (Printed Name)
CUST# 1059 RO# C543494 PG
TAG # START 12/05/07 11:3(
BILLED 12/05/07 11:3:
PO#
WRI T'ER 5 5 6
~r_r-.vrrr_ rrlvarrr
CUSTOMER COPY
LOIS K PEARCE
1560 DOUGLAS ST
DUBUQUE IA 52001
PHONE: HOME 563 583-6634 0 APPROVAL 556
------ WORK 563 589-2108 0
OWNER ----------------------
1059 UNIT# 7R256782 ------------
2007 DODGE -------------
GRAND -----------------
CARA CURR MIL ----------
2,921.1
DELIVERED: 8/30/07 TRANSMISSION: 4 SPD AUT
VIN: 2D4GP4 4L67R256782 ENGINE: 3.8 6 CYL
------
--- COLOR: INFERNO RED
(C) 1. ------
CONCERN: -------------
REPLACE R ------------
IGHT MIRROR ------------- ----------------- ---------
LABOR: 9.40
PARTS: 1.00 KSCH1321199 MIRROR 131.00 131.00
TOTAL LABOR 9.40
TOTAL PARTS 131.00
REPAIR ORDER SUBTOTAL 140.40
*SALES TAX 9.83
REPAIR ORDER TOTAL 150.23
COPY ONLY
~aiD ?ate ~3~e`
DEC o 7 2007
THANK YOU!
SERVICE DEPARTMENT HOURS
MONDAY - FRIDAY
7:30 a.m. - 5:00 p.m.
i~~~~ 90 KENNEDY RD.
DUBUQUE, IOWA 52002
~~~ (563)583-5781
(800) 747-4221
STATEMENT OF DISCLAIMER
The factory warranty constitutes all of the warranties with respect to the
sale of this item/items. The Seller hereby expressly disclaims all
warranties either express or implied, including any implied warranty of
merchantability or fitness for a particular purpose. Seller neither
assumes nor authorizes any other person to assume for it any liability
in connection with the sale of this item/items.
CUSTOMER SIGNATURE