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Claim by Terry FrostTHE CITY OF ~~ DuB E Masterpiece on the BARRY LIND CITY ATTOR To: DATE: RE: Claimant Terry Frost MEMORANDUM Mayor Roy D. Buol and Members of the City Council January 22, 2008 Claim Against the City of Dubuque by Terry Frost Date of Claim 01 /17/08 Date of Loss 06/20/07 Nature of Claim Vehicle Damage This is a claim in which the claimant alleges that a City of Dubuque refuse truck struck his vehicle while the vehicle was parked in front of 350 Klingenberg Terrace. 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 Paul Schultz, Solid Waste Management Supervisor Terry Frost 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 ,- ,~ ~~, a -, 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 West 13th St., 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 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: 2. Address: 3 ~v 3. Telephone Number ~~-~ ~ ~~~.~ V~~/ 4. Date of Incident: ~ 6 - zo~ ~7 5. Time of Incident: ~~ ~/~ ~/~ ;' 6. .fLocation off Incident (Be specific): L/ n,c„ (,',/~ .~`i ,~~iJie7 Or ~'1~/ i'/o.~'hG' ~ Ll~ 7 ~I ~ ~~ ar"~ (/~ ~~/ //Gr~rJ'i 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 the employ/ee's name.) C~~~~~> Ui7 ~ .u~.J~, ~-a~~ii ~ fl,~ Zd ~~ ri'~ G,~ G~'~ t ~i',~ c~ .~7`i ~ c %~ iri v~ l/Cli~ 8. What were weather conditions like? /~/~~ ~ - 9. Give name and address of any witnesses: ,%r+ c• ~~~~~ ~~ ~ ~'/t~i c G 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.) l 1 ~C's_ 'tic f~f ~r ~~~- /~~<l ~~ ~~-~ -li~',6~G %~'° ~C Gfb i~v~ /~7;3+r~r~al~i+. ~ ~ 13. What other damages do you claim, if any? 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.) 15. What mount do you claim from the City of Dub/~que? ©h Z G' .t ~ Ot rG~~ O f~ Lu 0 r ~ .~/ ~d , v C ~~. ~ ~ . O ~' /,~. i/ti~h~a .fir' !!> !/C'.v~ . ---- 16. Why do you claim the City of Dubuque is responsible? 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? • n ~, cx> ~~ ~ Dated this ~'~~ day of ~n~ti~~ , 20ods . ~- <<; z ~_ ..., { ~~~~ ~ (Signatu e) ~'~ 0 (Print Name) ~~~ r i~ 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) O~