Claim by Edward BeresfordTHE CTTY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN '~
PARALEGAL ~
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
June 30, 2009
Claim Against the City of Dubuque by Edward Beresford
Date of Claim
Date of Loss
Nature of Claim
Edward Beresford 06/23/09
05/20/09 Vehicle Damage
This is a claim in which the claimant alleges that the torsion bar on his vehicle was
damaged after driving over a pothole on Old Highway Road.
According to the report of John Klostermann, Street & Sewer Maintenance Supervisor,
while there were no Public Works records indicating that calls were received concerning
the wide seams and condition of Old Highway Road, a Public Works crew was working on
the shoulders of the roadway earlier that month. Consequently, Mr. Klostermann believes
that the Public Works Department would have some recent knowledge of the condition of
the roadway and would have had time to make necessary repairs before this incident.
It is therefore the recommendation of John Klostermann to approve the claim for $166.92
as filed. The City Attorney's Office concurs with this recommendation.
cc: Michael C. Van Milligen, City Manager
John Klostermann, Street & Sewer Maintenance Supervisor
Edward Beresford
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL tsteckle@cityofdubuque.org
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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: ~~~-G~~-~~ ~~s~P
2. Address: ~ -3 ~~G/ FT- ~7~<~-r~~7`-~
3. Telephone Number: S%rr~- .5 ~~/-U~
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4. Date of Incident:
5. Time of Incident: ~~%J /~L17
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6. Location of Incident (Be specific): ~~ ~ /~- ~`~GI G~Nc-~ D-~1~ ~~ ~ U 5 Z U
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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.)
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8. What were Bather conditions like? ~~ ~
;9. Give name and address of any witnesses:
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).
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.)
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15. What amount do you claim from the City of Dubuque? ~/~`r
16. Why do you claim the City of Dubuque is responsible?
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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.) v
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 ~ day of ~ ~y~ 20
gnature)
(Rev. 1/00 & 7101)
~int Name)
6 t ~S ~!~ ~ Z ~~~ 6Q
Mechanical Advantage Automotive Services
3-135 Cedar Crest Ridge Suite B
Dubuque, IA 52(}03
-~'3-537-76b3
E3iii To
Beresfi~d, Ed
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[)ate Irwoice
6/1112009 3664
P.O. No. Due Date MalceiM~s
6/1 i/2009
Despiptiott QuaMOy Rate Amamt
lesion bar
install bar
Salmi Tax 1
l.2 90.40
55.00
7.00% 90 OOT
66.OOT
10.92
Total 6166.92
Sigpature