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Claim by Durrant Group_Gary BechtelTHE CTTY OF DUB E MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: June 8, 2009 RE: Claimant Claim Against the City of Dubuque by the The Hartford on behalf of The Durrant Group/Gary Bechtel The Durrant Group/ Gary Bechtel Date of Claim 06/01 /09 Date of Loss 04/26/09 Nature of Claim Vehicle Damage This is a claim in which claimant alleges that a nearby retaining wall located at 400 Ice Harbor Drive fell and damaged claimant's vehicle. 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 Gus Psihoyos, City Engineer The Durrant Group/Gary Bechtel OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL tsteckle@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 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: ~2:0~ 3. Telephone Number: ~~ 3 5 ~ ~ `d ~ ~ ~ 4. Date of Incident: ~ ~d~Ll T j~ 5. Time of Incident: C7'Gr ~G boo 6. Location of Incident (Be specific): ~G ~ j L~ 1'T~-/~~ ~' ~~ 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.} y~ ; :~.e ~~a [ I -~-~ li F~~.-~ ~'e ~ (~ ~ c~~ Cap S ~ vie o~l~.~-~.a.s~~. 8. What were weather conditions like? Cr~t? Q+~ ~ ~i ~' LI 9. Give name and address of any witnesses: V1 ll h ~ 10. Did police investigate? (If so, give names of officers.} 1~ 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). PCN: 30014200905152001248 DCN: 30014200905152001248001 Received DateITime: 5115!2009 3:13:00 PM Page 2 of 6 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.} Mi ~~ q loo. ~ Gteat~ c~-{; bt ~ v 15. What amount do you claim from the City of Dubuque? ~' ~~ 3q , 3 16. Wh do you claim the City of Dubuque is r sponsible? 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) ,~ A U 18. If the answer to Question 17 is yes, have you received any payment from that ~s~ource, and if so, in what amount? C7 ~ ~_ C ~_ `~ ~: ~~=:, Dated at Dubuque, Iowa this ~ day of 20~. -`= ..~, -~• --_ ' ,' rv (Signature) `~' {Print Name} e {~.~-~---~r ~ C'..ta.~,rv. ~- C,lo4 ~ •SC.Ga X5,.38' (Rev. 1100 ~ 7101) ~ ~~ ~ ~~ ~~cbn ~7 uv~~~ PCN: 30014200905152001248 DCN: 30014200905152001248001 Received DateITime: 5/15/2009 3:13:00 PM Page 3 of 6 630 6926612 Fax 2D2 11:28:34 a.m. 06-05-2009 2/2 72. 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 ail of your claim by any insurance company? (If so, give name and address of insurance company and amount paid.) tl _. --ri... lln ..,1.~ _,~ ~-n Q ~n u ~ ~ n r>f !S ~ ~ /fit} v~r~l~ P.4 i~Vl i n~_ al ~'IOD. tk~ deCC~ c_ b(4 16. What amount do you ciairn ram the City of Dubuque? ~'t~ ~ . 3 1fi. Wh~l d~D you claim the City of 17. Have you made any claim against anyone eise for damages as a result of this incident? (if yes, give name and address,) ~~l 18. If the answer to Question 1T is yes, have. you received any payment frorri that source, and if so, in what amount? E~ ~ . --,- Dated at Dubuque, Iowa this ~ day of _ ~_...+ z0.s~• a' ~. - n v3 ~ '`.: G N Q ~" CD ~ 07 ~e. ~tY-~--~rOl ~.0.ilv~ ~!. '~' ~' MCP+~3$ (Rev. 1100 8 7/01) ~ JU ~ ~e.ir •~ ~7 vw~~ ~~- l~~~'-acosa ~~ ~taa PCN: 30D14200905152001248 DCN: 30014200905152001248001 Received Datefrfine: 5/15/2009 3:13:00 PM Page 3 of 6