Claim by Hazel CurielTHE CITY OF
DUB TE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
AP
To: Mayor Roy D. Buol and
Members of the City Council
DATE: February 22, 2010
RE: Claim Against the City of Dubuque by Hazel Curiel
Claimant Date of Claim Date of Loss Nature of Claim
Hazel Curiel 02/17/10 01/22/10 Vehicle Damage
This is a claim in which claimant alleges that her vehicle was damaged after she
attempted to park the vehicle in front of 395 W. 17 Street and struck a pothole.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
John Klostermann, Street & Sewer Maintenance Supervisor
Hazel Curiel
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
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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This written L�U
tten 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. 13 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: ,%7...e/ dii
2. Address: 1 (1)- , -e-4 - Dckto v¢
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3. Telephone Number: s-6
4. Date of Incident: /- a --[(j
5. Time of Incident: a p - oroX
6. Location of Incident (Be specific): r ri- k k j S Inca-tee( ;vi - cry) a+ o4
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7. DESCRIBE ACCIDENT OR OCCURRENCE ENCE THAT CAUSED INJURY OR DAMAGE. (Give
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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 weather conditions like? !j(t , 2_ ea c
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).
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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.)
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15. What amount do you claim from the City of Dubuque?
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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.)
16. Why • o you cla' t - City of ' ubuqu - is r- s • • nsible?
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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.)
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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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OK Bad
BIG A AUTO PARTS & SERVICE
2311 CENTRAL AVE
DUBUQUE. IOWA 52001
(563) 556 -1123
BUY4 OIL CHANGES AND THE 5TH ONE IS FREEII!I' U!
Customer : CURIEL, HAZEL
Address : 1327 W 5TH
City : DUBUQUE, IA 52001 -
Phone 1 : ( 563 ) 495 -8555
Phone 2 : ( 563 ) -
Ext :
Ext :
Parts
Quan Part Number
Description Price
1.00 801667 SHOCK 105.35
Recommendation
THANK YOU FOR YOUR BUSINESS
STORE HOURS:
SERVICE: 8:00 TO 5:00 MON -FRI
PARTS: 7:30 TO 6:00 MON -FRI
8:00 TO 12:00 SAT
CLOSED ON SUNDAYS
VEHICLE : 2002 DODG INTREPID
LICENSE :
V.I.N :
ENGINE :
MILEAGE :
TRANS:
Labor
Op Tech Description
GN REMOVE & INSPECT OR REMOVE & REPLACE
FRONT SHOCK & /OR STRUT ASSEMBLY
Time Charge
74.80
OK Bad Recommendation
OK Bad
Repair Order #0292018
Date Printed : 2/15/10
Page : 1
Center : 2
Recommendation
Paid By :
Pay Ref :
Labor: $74.80
Parts : $105.35
Sublet : $0.00
Other Fees : $0.00
SUPPLIES : $3.60
Subtotal $183.75
Sales Tax : $12.86
Total: $196.61
Paid : $0.00
Due : $196.61