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Claim by Dennis McCarthyTHE CITY OF DUB E MEMORANDUM Masterpiece on the Mi s ssippi BARRY LINDAH~, CITY ATTORN Y To: Mayor Roy D. Buol and Members of the City Council DATE: July 11, 2008 RE: Claim Against the City of Dubuque by Dennis McCarthy Claimant Date of Claim Date of Loss Nature of Claim Dennis McCarthy 07/10/08 June 2008 Property Damage This is a claim in which claimant alleges that the gate to his patio was damaged during the course of a police investigation. 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 Kim Wadding, Chief of Police Dennis McCarthy OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 30O MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.org ~. ~- 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. r'1 D n n /\ 1 1 1. Name of Claimant: 2. Address: l _~ ~, ~, _ ~ ~ L~ I ' ~~""''~ ~ ,, ; ~ 3. Telephone Number ~~~~ - -5 ~~ -~~s~ 4. Date of Incident: ~ . ~(~~ 5. Time of Incident: ~ ~l f C' 1, ~ u~o i~ ~ (V l~ 6. Location of Incident (Be specific): ~ ~~~fY~l1GE ~n ~f !" ~a~~O - 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 employee's name.) 9.-Give name and address of any. witnesses: 10. Did police investigate? (If so, give names of officers.) L ~~ C c~S~ fi~,~~~y 8. What were weather conditions like? 11. Was anyone injured? (If so, give names, addresses, anal. extent of irijuries). ,~ ~ o ~ ~ © w e c~ ec v~ ck ` '~ i ~ u _ was b~orkEn - a a ~_~ 13. What other damages do you claim, if any? N 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 ) 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.a_nd amount paid.) ~O 15. What amount do you claim from the City of Dubuque? f ;~ 16. Why do you claim the City of Dubuque is responsible? n c~r^ 17. Have you made any claim against anyone-else for damages as a result of this incident? (If yes, give name and address.) No 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? Dated this ~ day of ~ v it ~ ~ '~_ (Signature) (Print Name) 20~~. n ~ _ Q`< ~~' ~ _T " ~ _ _ o ~,~ ' ~ c'=~ ~ ~ -r~- .~ ~ r• i;~ ~ 1 'i ~J DENNIS M MCCARTHY MARLENE E MCCARTHY PH 563-582-0652 1355 WASHINGTON ST a5aa5sl2~asAX DEDUCTIBLE ITEM - CI ' 4181 DUBUQUE, IA 52001 BAL. FWD. THIS CHECK TOTAL MISC. BAL. FWD. ~: 2 7 3 9 7 4 5 8 1 ~: 0 0 0 4 6 1 5 0 911' ~+ l 8 b NON NEGOTIABLE ~~ 20% post-consumer material r~s cm of ~ ,- ~ \ `Dubuque Police Department T ; ~ ~" Law Enforcement Center D LT B V ~~~~ (~ P.O. Box 875 ~ xj Dubuque, Iowa 52004-0875 ~e 'y (563) 589-4415 office ~ ~~~ ~ (563) 589-4497 fax ~ " X11 L^ ~ ~ 1 Emergency \~,,~ ~~ • Q~ Andrew Harden ~~ ~~ a ~ Patrol Officer o~~ ~,~ Case No.08~'~-5311 J