Claim by Walter Barger Jr.THE CTTY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL
CITY ATTORNEY
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
February.28, 2008
Claim Against the City of Dubuque by Walter Barger, Jr.
Date of Claim
Walter Barger, Jr.
02/28/08
Date of Loss Nature of Claim
01/11/08 Vehicle Damage
This is a claim in which the claimant alleges that his vehicle was damaged after driving
over a pothole located in the right turning lane in front of 2805 NW Arterial (Buffalo Wild
Wings).
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
John Klostermann, Street & Sewer Maintenance Supervisor
Walter Barger, Jr.
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
Claitn Form '
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1,
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 13~' 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 Counal. 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 ad~s to whether your claim will or wi-1 not be paid.
1. Name of Claimant L,....' . , 1 ~-' f L-1 ~~, r ( T r-
2. Address: ~-/ ~ %r ~, . i,,~ ~ ~ :: c~ ;~, e`'n; l i ~ ~ .
3. Telephone Number: ,~ ~ S - jcTi Ly 1 `7 ~.~
4. Date of Incident: 111 t0~
5. Time of Incident: ~ ~~ ~t ~(::+ ~_,~.~...
6. Locatiolln of I ncident (Be specific): y ~~ . ~\ ~s' ~;, __ _ j , ~,, ~, ~ ~ ,-+ ~L
\ n T~ i! \\~ Q ~ ~V.~~G~ I ii Vii t `ci ~ 1 Yl f..S ~~~
7. Describe the acddent 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 likes ~~r r~ r~ v -t (~~~
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9.``\\Give name and address of any witnesses: ~h ~~~ui~~y.r I.~;,~~;, ;" - ! jr ~~~~f -~c °~
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.) \
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13. What other damages do you claim, if any? ~ cN ('
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Claim Form Page 2 of 2
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14. Have you been compensated for any part or all of your daim by any insurance company? (If so, give
name and address of insurance company and amount paid.)
15. What amount do you daim from the City of Dubuque? ~~
16. Why`` do you claim the City of Dubuque is responsible ~~ c- rl t~-~- -~~~ a n ~ ~:;t
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17. Have you made any claim against anyone else for damages as a result of this inadent? (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 ~~ -day of _~~,,L~ ~ - , 20~.
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