Claim, Fedderson, MarlaCLAIM 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 W. 13th St., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for investigation.
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: Marla Fedderson
2. Address: 205 Valley St
3. Telephone Number: 563 588 0090
4. Date of Incident: May 2002
5. Time of Incident: came home it was there
6. Location of Incident (Be specific): In front of house East
7. DESCRIBE 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.)
City tree fell on House... took down Power Line and land on house
8. What were weather conditions like? Fair
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Park Patrol
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
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.)
Yes Storm Door - Combination windows - corner post vinyl siding - brown fascia - shingles - Gutter Labor
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.)
No
15. What amount do you claim from the City of Dubuque?
$881.76
16. Why do you claim the City of Dubuque is responsible?
City Tree
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 at Dubuque, Iowa this 24th day of June , 2002. .
/s/ Marla Fedderson
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
· CL/~IM 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 W. 13th St., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for investigation.
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. Telephone Number:
4. Date of Incident: !-~ ~, \/ ,~(~ ~
5, Time of lncident; Ct~r~e ~om¢ -~-~ ~;c~ ~
Location of Incident (Be specific): -~ ~?0~-~ C~ /~(25~_ .~'~,~ -J-
7. DESCRIBE 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.)_
8. What were weather conditions like? ~-- ~
9. Give name and address of any witnesses:
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.)
Yes storm door- combination windows- corner pose vinyl siding- brown fascia- shingles- gutter labor.
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.)
No
15. What amount do you claim from the City of Dubuque?
$881.76
16. Why do you claim the City of Dubuque is responsible?
City Tree
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
18. If the answer to QuestiOn 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this 24th day of June , 20 02.
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
WSC MOBr[.~ HOME SERVICE
33 33RD AVE1,RIE SW
CEDAR RAPIDS~ IA 52404
(319)366-6848
Fax (319)366-4205
Estimate
DATE ESTIMATE
6/1~r20o2 ~9
NAME / ADDRESS
Mm'la Feddex~a
205 VaIl~
])t]du~Iowa 5200
PROJECT
ITEM DESCRIPTION QTY COST TOTAL
[ REf, ALE 1TEM 30~X80. g/Ht'IE STORM DOOR 1 189.00 1 gg.00T
~BOR LABOR CHARGE PER HOUR TO INSTALL STORM 1 45~00 [ 45.00T
DOOR
RESALE ITEM 26"X28" COMBINATION WINDOWS 3 39.00 11Z00T
LABOR LABOR CHARGE PER HOUR TO INSTALL 1 ~5 45.00 67.50T
W]lffDOWS
RESALE ITEM 10' GRAY CORNER POST 1 1&95 18.95T
LABOR LABOR CHARGE PER I-K)UR TO INSTALL CORNER 2 45.00 90.00T
POST
RESA[~ flEM GRAY VINVx'L SIDING 3 8.00 24.00T
LABOR LABOR CHARGE PER HOUR TO INSTALL SIDING 0.75 45~00 33.75T
RESALE iTEM t0' BROWN FASCIA 2 14.00 2g,00T
LABOR LABOR CHARGE PER HOUR TO INSTALL FA _.e~,,'"lA 0,5 45.00 22.50T
Pd~SALE iTEM BUNDLE BROWN SHINGLE8 2 14.95 29:90T
LABOR_ LABOR CHARGE PER HOUR TO INSTALL 1.25 45.00 56..25T
S~
RESALE ITEM BROWI'q 5" GlYl_-t mt PER FOOT II'~$TALI,ED 22 5,00 110.00T
REPAIR HOM'R, DUE TO TREE FAI.I.1NG ON HOUSE
SALES TAX/LOCAL OPTION TAX 6.00% 49.91
TOTAL
SIGNATURE