Claim by Steve CookTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the
BARRY LIND HL
CITY ATTORNEY
To: Mayor Roy D. Buol and
Members of the City Council
DATE: January 2, 2008
RE: Claim Against the City of Dubuque by Steve Cook
Claimant Date of Claim Date of Loss Nature of Claim
Steve Cook 01/02/08 12/20/07 Property Damage
This is a claim in which the claimant alleges that a large amount of snow fell from the
City Hall Annex roof onto his building, damaging the building's wooden porch, awning,
iron railing, window screen, and cement at the base of the railing.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
BAL:tIs
cc: Michael C. Van Milligen, City Manager
Jeanne Schneider, City Clerk
Rich Russell, Building Services Manager
Steve Cook
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.org
CLAIM AGAINST THE CITY
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OF DPJBUQUE,
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This written report constitutes your claim against the City of Dubuque, Iowa. You
should complete this form in full and attach any additional informatior~Qi~~1N -2 A~1 ~~' 3Z
supports your claim.
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The claim must be filed with the City Clerk at City Hall, 50 West 13th St., (~;~' t,~~u~:, ~~~
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. 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 Dubuctue has the authority to make any representation to you as to
whether your claim will or will not be paid.
Name of Claimant:
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2. Address: // ~ ~ ~ ~ ~1~~~/~~ -
3. Telephone Number
4. Date of Incident:
5. Time of Incident: -s' -3~~~'"'~
6. Location of Incident (Be specific):
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7. Describe the accident or occurrence that caused injury or damage. (Give full
details upon which you base your claim. If a City employee was involved, give
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8. What were weather conditions like?
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9. Give name and address ~ any witnes es: 1 / ~i -
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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.)
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13. What other damages do you claim, if any? ~~~~~~ ~~, ~~,~ ~- ~,~~ ,~ 5~.5 ~
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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? (If yes,' give 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?
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Dated this y of ~~~ ~/~%'~/~ , 20 ~ 7
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14. Have you been compensated for any part or all of your claim by any
,Dec~21~ 2007 6~36PM MERCY SERVICES CORP.
Asburyr ~om~ ~mprov~rr~ent
2332 Burr Oak
Asbury, Iowa 520Q2
Phone & fax (563) 583.431
owner -Mark A. nEernmers
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2332 Burr Dak ~'~"
Asbury, Iowa 5242
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Phone & Fax (563) 583-4431
weer ~ IVlark A. Nemmers
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Re:
~STI~VIAT~ ~`
Unit arr~oun~t
Quantity Description price
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Customer Signature pate
Owner Signature °~ Date ~~'~~ ~-.~7
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17'0 W 11TH ST
DUSIIQIIE IA 5200,
(563) 513-0599
)563) 543-1472
Proposal Suhmltt?d to; ~~,~ ~ c~n~ ~ Job Name Job sk
Adnress Job Location ~~ ~ ~ /~ i N ~ / ~' ~/ ~(.~
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j Date of Plana
Phony # Fax & Architect
WP hereby submit specitlcatlons and estimates tor' --.---.----..---.- ............ ............__.......-...._..._..............._..--......
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We propose hereby tp fiarnish ma#eris~l and labor -complete in accord~lnce with the above specifications for tht~ sum of:
$ _~•--.. Dollars
with payments tb he made as follbvus~ ~~~~ Gy--w~..~._:_1i orN
Any :~Iror.~tllon or dOvihtlan rrom above spedflcetlons Invelvlnp oxtr.+ rxr:.gs wlll no Fie9p6ctfUlly /~/y~~
ex¢cuted only ~ilxrn wrltT!+n ~)I'dgr, iU1d wilt UOC9111rr iin oxrrR chRR~e over rand gubTTlitted ~.~ - y ~•~~"'~7_
above the rrr•,rlmnrR. /111:.1Qrotetnent5 r,0ntlifgonr llpOfl ,tdkR~, RecldRnts, or dRtnye ~- •.-
beyond civ rnntrnl, Nalp - Ihla proposal may be wlthdrawm by us it' nOt aCC8pt0tl anthill _~„-,,,., days.
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The abova Ares a Pnlfir.Rlirtns and rnndltlnnR are sattsfbcto and are ~1
F ~' ry Signature , ~-+'
hAmby aaC.eptocl, You om autliorizod to db the work as cpgr..ifted.
Payment., will bo made Fl., ntttllnPd Abovta.
fJati~ of AcceotaneP Signature
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