Claim Herbst, TammiCLAIM 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: Tammi Herbst
2. Address: 10440 Timothy
3. Telephone Number: 563 583 3404
4. Date of Incident: October 8, 2002
5. Time of Incident: Unknown
6. Location of Incident (Be specific): Parking Space #335
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.)
My car was parked in my assigned space at the Locust St. Parking Ramp. The outside stairwell by my car was being painted. UPon finishing work a note was left on my car by Tim at the parking office stating to come see them b/c they got paint spattered
on my car and they would ???? to take care of & fix the problem so the paint would be removed from my car. They requred that I get 2 estimates o cost. That was completed.
8. What were weather conditions like?
Sunny day
9. Give name and address of any witnesses:
None - you may look at my car and see the paint spattered if you wish
10. Did police investigate? (If so, give names of officers.)
No, b/c a note was left on my car.
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, there is paint spatter to all sides of my car. Damage is $120 (+) that would be for paint removal and buffing ($121.85)
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?
$121.85
16. Why do you claim the City of Dubuque is responsible?
The City is responsible because they hired the painters that were responsible for this and they also left a note on my car stating that they would pay to correct the paint being removed from
my car. Tim at Parking Office requred that I get 2 estimates. I went to ABRA. They refrred me to Chuck's Detail and Refinishing. They stated that they are the only place that will/can do the removal without
repainting the cost. Estimate was turned into the parking office.
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 17 day of October , 2002.
/s/ Tammi Herbst
The two days following paint on my car there was a cone in my parking spot as well as other spots preventing me from
parking there, so they could finish painting the outside of the stairwell.
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST'THE CITY uP uuuuuu=, IUWA~. ~-~
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 Incident:
6. Location of Incident (Be specific):
L
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
emp, lovee's nameA . , ,
I
9. Give name and address of any witnesses:
101 Dad p~lice investigate? (If sq, giye,names of officers.)
11.' Was anyone injured? (If so, give names, addresses, and e~ent 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.)
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 amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible~ (~J~t,~ i*~ I~%~D~ L0~
17. Haveyou m~~m~t ~.~~~a~, a result~this,nciden,. ~
(If yes, give name and addreSs.) ~ ~ ~~~
18. If the answer to Question 17 is yes, have you received any pa~ ~r~~~~
and if so, in what amount? ~~'~ ~~
(Signature) ~
~ ~b~ ~ ~ ~ (~in, N~me)
DIIBr, Bem odmm mi BiB
610 E. 14~ Street Pl~one: (563) 582-0775
Chuck Ostrander Owner
TICKET # 1 0 7 8 1 DATE:
DEALER:
YR. AND MAKEAUTO ~-~ ~~'4~ ~'.~or~r' COLOR ~,<~.~
COMPLETE DETAIL ~'~'~-~:~ ~/.~?' $
'PAINT $ TOUCHUP ~,.~...,~. 7z~'~ ~.~-.c/ $ //-"-/ ~' ~
DELUXE WAX .... ~. ~ $
ECONOMY WAX
ULTIMATE WAX
CLEAN MOTOR
SEAL MOTOR
PAINT MOTOR
COMPLETE MOTOR
SHAMPOO SEATS
SHAMPOO CARPETING
COMPLETE INTERIOR SHA%lP~
ARMORALL
INTERIOR
D ETAI L
NEVV CAR
OTHER
SPECIAL A-I-FENTION TO:
,NSPEC~-ED ~__________-'~'
COMMENTS:
~ $
$
SUB TOTAL $ //¢,/..,~..5'~
SALES TAX $
TOTAL
THANK YOU FOR YOUR BUSINESS
IF YOU HAVE ANY COMPLAINTS OR SUGGESTIONS
PLEASE ASK FOR CHUCK OSTRANDER