Claim by Jenni RuffridgeTHE CITY OF
DUB E
Masterpiece on the Mississippi
MEMORANDUM
BARRY LINDAHL ,(I~~, ~~
CITY ATTORNEY 11Q"~"' 111
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
March 17, 2008
Claim Against the City of Dubuque by Jenni Ruffridge
Date of Claim
Jenni Ruffridge
03/13/08
Date of Loss
02/10/08
Nature of Claim
Property Damage
This is a claim in which the claimant alleges that the water main broke under Groveland
Avenue causing water to flood claimant's basement and garage.
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
Bob Green, Water Department Manager
John Klostermann, Street & Sewer Maintenance Supervisor
Jenni Ruffridge
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 /FAX (563) 583-1040 / EMAIL balesq@cityofdubuque.org
Claim Form
Page 1 of 3
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City Clerk
First floor of City Hall, 50 W. 13th Street
Phone: (563) 589-4120
Fax: (563) 589-0890
Hours: 8 a.m. to 5 p.m. Monday through Friday
Email: jschneid at7citvofdubuque.orq
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. You should comple
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
referred to the appropriate department for investigation and to the City Attorney's Office. Once 1
is completed, a report and recommendation will be submitted to the City Council. You will be prc
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
authority to make any representation to you as to whether your claim will or will not be paid.
1. Name of Claimantp ~ (,~
2. Address: ~~(~O ~~Y1~1
3. Telephone Number: ~~3`~ l (z~/ 7
4. Date of Incident: ~~~
5. Time of Incident:
6. Location of Incident (Be specific): ~~~ DGt/~~C.-~4'1 ~ ~Pi~ Lfc.l
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7. Describ~'fhe accident or occurrence that caused injury or damage. (Give full details upon whi
your claim. If a City em loyee was involved, give the employee's name.)
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8.jWhat were weather conditions like? 11,,,, ~~'.~' f ~
9. Give name and address of any witnesses:.v.Yl ~ Uli ~~{ . ~ ~P~,lflt
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10. Did police investigate? (If so, give names of officers.)
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http://www.cityofdubuque.org/index.cfm?pageid=155 2/14/2008
Claim Form
11. Wa$ anyone injured? (If so, give names, addresses, and extent of injuries.)
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Page 2 of 3
12. Was any damage done to property? (If so, describe property and the extent of damages. Att
mages or describe basis for ascertaining extent of damage[,.,,,)
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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? (li
and address of insurance company and amount paid.)
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15. What amount do you claim from the City of Dubuque? ~o~ ~~ ~~)Gtx-Y h ~QGt
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16. Why do you claim the City of Dubuque is responsible? i~(~-k'V ~ ~ / {~ -Y!
17. Have you made any claim against anyone else for damages as a result of this incident? (If y
and d r ss.)
18. If the answer to Question 17 is yes, have you received any payment from that source, and if
amount?
Dated ~~_ day of l /~ ~ , 20 C.~~
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