Claim by Richard & Mary Rokusek®~
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~h 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.
1. Name of Claimant: ¢~) G 1-d A ~] /-~ n!~ ~ AR ~ ~ ®1~ S" ~
2. Address: ~ 1 ~ ~ ~... 1n/ ~ ~ ~~
3. Telephone Number: _ ~;,3 ~~ ~ °~ ~.,.~
4. Date of Incident: ~ ~ /-~ P2 '~
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5. Time of Incident: ~ PE~Ri7X ~~:1 t~ IJ~ '~~~~'~t ®c9
6. Location of Incident (Be specific): f~ ~~!'~ c~ t= ~ / ~3 ~ 1~1 GC~~ TL
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.) e-nR s-7t=~i~ t~R ~'~~t~2 ~ avig~D'~~.~T 'TKO ~~E
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8. What were weather conditions like? ~~!c.~~,~~~ ,ham ~ ~~,~~~
9. Give name and address of any witnesses: ~ ~~~,,., e~ ~ ,~ f. - ',~ ~~ .~~, ~ ,.
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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.)
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12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of
damages oar descr~i)be basis`fo~r a~sc/ertaining9extent of dgamage.) f~
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13. What other damages do you claim, if any? ~ 1 ~~ ~ i~ .~ ~~,~ -:~'~~ ~
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.)
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15. What amount do you claim from the City of Dubuque? ~ ~ f~ , ~ ~7~ r ~ ~ ~~
16. Why do you claim the City of Dubuque is responsible? ~.r~.~~ ~,~~ ~ t ~ ~`` %-~~
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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?
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Dated this ~ day of r"'~- , 20
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Additional background information: (Fallen tree behind 2183 Lincoln)
Nearly four years ago Mr. Jerry Zeimet (2112 Shiras Ave)
whose property abuts the city owned property (where the tree
existed), contacted the City Of Dub to request removal of the
threatening tree. The City did respond and set up a date for removal.
The City contacted me by phone requesting that I move the said RV
so they could access the leaning tree for removal. I took a day of
vacation from work and moved the RV and gave permission to use
my yard for access to the tree in mention. The crew arrived in the
morning with their equipment and accessed the tree but was then
apparently called away and never returned. A week later I contacted
the Park Dept to try to set up a new time so that I could
accommodate access through my yard for their equipment. I was told
that they were at that time very busy (running behind schedule) with
spring clean-up work and preparing the parks for opening. They did
say that the tree removal would be on their list of upcoming jobs.
Neither Mr. Zeimet nor myself heard anything back from them since.
do believe Mr Zeimet had called another time within the last two
years with another request to have the tree removed or at least
topped off.
The tree did apparently have a disease for quite some time
which left a large hole near the base on the rear of the trunk at
ground level.
Compliment to Park Dept Mr Steve Pregler and Crew.
Although my wife and I are very upset about the fallen tree
must comment on the extremely quick response displayed by Mr
Pregler and his crew. They did a very professional job removing the
debris and restored our yard lawn that was damaged from the tree.
Mr Pregler did everything he could to minimize any additional
damage to the RV while removing the tree. I was very impressed with
the care he took to keep damage to a minimum.
On May 20 '09 the city tree crew returned to remove the fallen
tree stump and also cut and removed a smaller tree which was also
leaning over and posed a future threat.
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CUSTOMER'S ORDER NO. PHONE DATE
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Richard and Mary Rolcusek
2183 Lincoln Ave.
Dubuque Iowa 52001
563-588-4737
1997 COACHMEN CATALINA 32 FT REAR KIT. TWIN SLIDE-OUTS.
RV DAMAGE LIST INCLUDES THE FOLLOWING BUT IS NOT LIMITED TO
THESE ITEMS PENDING REVIEW OF SERVICING DEALER.
ROOF TOP EXTERIOR COMPONENTS:
A. ROOF AIR CONDITIONER COVER IS BROKEN
( A/C IS ALSO INTERNALLY DENTED AND SHOULD BE
CHECKED OUT FOR INTERNAL DAMAGE)
B. TV ANTENNA METAL BASE IS BROKEN AND THE PLASTIC HEAD
SECTION OF THE ANTENNA IS BROKEN.
C. THE ROOF TOP LUGGAGE RAIL IS BENT.
D. THE REAR ROOF VENT COVER IS BROKEN.
E. THE REFRIGERATOR ROOF VENT COVER IS BROKEN.
ROOF TOP STRUCTURE:
A. THERE ARE AT LEAST THREE PLACES ON THE ROOF THAT THE
SHEETING UNDER THE RUBBER IS BROKEN THRU. IT IS NOT
KNOWN IF THE ROOF RAFTERS ARE DAMAGED BENIETH THE
ROOF SHEETING.
B. THERE ARE AT LEASE FOUR RUBBER ROOF TEARS EXPOSTING
THE ROOF SHEETING.
C. THERE ARE AT LEAST TWO COMPLETE ROOF PUNCTURES THAT
PENETRATED BOTH THE RUBBER AND THE WOOD SHEETING.
ALUMINUM SIDING AND TRIM:
D. THE VERY TOP GUTTER ON THE LEFT SIDE IS BENT AND
DEFORMED IN SEVERAL PLACES.
E. THE BEDROOM SLIDE OUT GUTTER IS BENT AND DEFORMED.
F. THERE ARE SHEETMETAL DENTS ON THE FRONT BEDROOM
SECTION BELOW THE GUTTERS.
G. THE REAR SHEETMETAL IS EXTENSIVLY DENTED. (THE AREA
BENEATH THE SHEETMETAL MAY OR MAY NOT HAVE BEEN
DISTURBED. THIS WOULD HAVE TO BE REVIEWED AFTER THE
SHEETMETAL IS REMOVED.
H. THE REAR CORNER SHEETMETAL SIDING TRIM IS PULLED AWAY
FROM THE SIDE OF THE UNIT. IT IS NOT KNOWN IF THE CORNER
STRUCTURE WAS DAMAGED BENEATH THE SHEETMETAL.
I. REAR MARKER LIGHT BROKEN.
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REAR SIDING IS DENTED AND GOUGED
DON'T KNOW IF DAMAGE OCURRED
BEHIND THE SIDING?
THE LEFT REAR VERITCAL CORNER JOINT
HAS MOVED SLIGHTLY TO THE REAR
,. EXPOSING THE SIDE SIDING EDGE
THE CLEARANCE LIGHT IS BROKEN
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COVER IS BROKEN
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BROKEN
MPACTED
DAMAGE )
INTERNAL
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ROOF TEAR ABOVE BEDROOM AREA
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ANOTHER
BEDROOM
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TREE BRANCH PIERCED ROOF AND
IS EMBEDDED.
ROOF SHEETING IS BROKEN
BENIETH THE RUBBER IN SEVERAL
PLACES FROM IMPACT
ROOF TEAR.
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N LACE ~5.