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Claim by Maryann UpmannTHE CITY OF DUB TE MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL ,kp, To: Mayor Roy D. Buol and Members of the City Council DATE: March 17, 2010 RE: Claim Against the City of Dubuque by Maryann Upmann Claimant Date of Claim Date of Loss Nature of Claim Maryann Upmann 03/15/10 03/04/10 Vehicle Damage This is a claim in which claimant alleges that her vehicle was damaged after she drove over a loose piece on concrete near the entrance of McDonalds at 2250 Flint Hill Drive. 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 Maryann Upmann 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 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 St., Dubuque, IA 52001. It will then be referred to the appropriate department for investigation and to the City Attomey'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 . 1. Name of Claimant: 1().` � NC111 Uprk - )011(\ 2. Address: ►► WoShl kn i "- Q)plle� iA(2, I,A Number: � - 5? " �J 3. Telephone Nu �t� a' 5 4. Date of Incident: 5. Time of Incident: 6. Location of Incident (Be specific): 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.) RS Oft W Pn' d r i v e nq kp - burn ' nit 01 s 2 rrki'o NCe Colo(' ) \IN +1-,L pn(->!i j Int) j i1P. s �'1efVc� ar\Cl 1 ckc rid pag Q 8. What were weather con • itions like? 9. Give name and address of any witnesses: 7 V f . - 1 - 111 , 1 / 1 C h D R 10. Did police investigate? (If so, give names of officers.) 11. Was anyone injured? (If so, give names, addresses, and extent of injuries.) VD< CI % NV l- f d - r\P ci Q\,[cc tnn C ,Ixn a I ova htet ( �S 0-1 � ( M•5 ,n�.m liY fl) ease Ct rn Cc 11 Q C of\ t)�, t)9/ p �hr h e y I 1� ?)D am Owl* o-C 'vihkc1e Mary 0-4\n U groom 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.) A ho\e vac (Y1(tcSi +n The -'Cu v't' P1 n'CO -4,42_ e tP (P c,-F In ©.sr eP (TV ( , 11� l�e 4 _�, \C1 \t1 Q N �n(ZSPtrtkQC -1 if CQI all thjtNS \RA_ 04 1ma\k l k\-ly Ce--Core m a --) al 0 r - aiUa61e dv� ►fkrn ed ► a\-01 ?ac Icy 4 Cap' and- nub cecl- Ot- \-c a► \ 0 k-ec1 CV -Cior,(■ w11eic t■L- hLa �Se lacy, u�■e_ wire. 'a no a,�c� a 9 �a�c a1 so real c\,6 . tifo n ► ns peck or) , we, DD-V\ cth 4)noc\ wh t r∎ c Ise 0 o ccut A ) •1 was Q a.r3Q `�- Lbv r o 1 Ca.0 se c1 44v. da►�a g �- w I� e n at- v �� a kS b\iker 0- b1 dc v ►n edge k,vhIch oh m C used 46 C r P° P d Lc t corn/ +el y dam ago_ - car , er o r wve re- no i o 0� -4 -\n e re, olrIv�� oUPr on art' show \n y� slb sirs (:)-P a s 1 \ooSc., Caere-, Wa c T Aknt , C\ UJh 1 1 e :r Nonino10 SAD 'E\ dk r veNcl e_ had psi- c r o \Q c.)Ver xv'(\ 2 arc a cA \ac9�. Con cre){ block. (k ar p move g nub* Qok cub) c lAforks o-P6C oP what l c� and a \Sc> me alt r^ \j dr\o,∎a)s w 110 b \ocio6- -41_e Qr cam. S1k(2. repov#d VY)a-k- 4 'W0.s i)0; f \mey_ a pain o vIc r e � -e area b h u s t1-C , '0C kxS \eov q\ Yka Bill To Invoice # Maryann imann Washington st Bellvue IA 12031 203 Date 3/4/2010 MILEAGE YEAR/MAKE VIN NUMBER 26764 1997 Intrepid Quantity Item Code Description Price Each Amount 1■1 11■1 al Part- Used TRANS SERVICE -... Notes Part-Used TRANS SERVICE -BASIC Vehicle bottomed out or hit a piece of concrete in the road IA Sales Tax c2 1 41 ‘., r ‘ W 20.00 79.95 0.00 7.00% 20.00T 79.95T 0.00T 7.00 SIGNATURE TotaI $106.95 PRECISION TRANSMISSION Invoice SERVICE OF DUBUQUE 806 WACKER PLAZA DUBUQUE, IA 52002 OWNER- LUKE MERFELD (563) 585 -0270 Mitch and Tina Kelchen From: <kelchenfamiy©ivuenet.com> To: "A Home" <kelchenfamily(Qivuenet.com> Sent Friday, March 05, 2010 12:14 AM Attach: IM000070.jpg Subject IMG00070.jpg Sent from my BlackBerry® wireless device from U.S. Cellular Page 1 of 1 S QP Q D\°C 0 1/4 \ 3/5/2010 Mitch and Tina Kelchen From: <kelchenfamily©ivuenet.com> To: "A Home" <keichenfamily ©ivuenet.com> Sent Friday, March 05, 2010 12:14 AM Attach: IMG00074.jpg Subject: 1MG00074.jpg Sent from my BlackBerry® wireless device from U.S. Cellular Page 1 of 1 IC\r\\ t\-V . Q\W Q\o zPs x\ (00- ,ero o,)N 4-c t o- VCt o gj 3/5/2010 Mitch and Tina Keichen From: <kelchenfamiy©ivuenet.com> To: "A Home" <kelchenfamily@ivuenet.com> Sent Friday, March 05, 201D 12:13 AM Attach: IM000069.jpg Subject IMG00069.jpg Sent from my BlackBerry® wireless device from U.S. Cellular Page 1 of 1 3/5/2010 SOLD BY OTY. CASH C.O.D. CHARGE DESCRIPTION ON ACCT. MDSE. RET'D. PAID OUT PRICE AMOUNT _ SCfv .e e"- 7- 11 i / `- ,2f ry i ' J - d / r, fi . 0• -.., 704:4 ,r/ 0 � / I I / I 67g..2 / TAX 3, �7 RECEIVED BY ' �C'-� TOTAL , ,� CUSTOMERS ORDER NO. Wenzel Towing & Repair, Inc. 24 -Hour Towing Service 3197 Hughes Ct. Dubuque, IA 52003 563-556-6480 Fax 563- 556 -3015 Mastercard & Visa Accepted PHONE NAME ,, J) /' Ain C/,rh ,,¢a rt ADDRESS 7 / et?' - GI/,pido;7 y to ,,. 5/ . y�� DATE All claims and returned goods MUST be accompanied by this bill. 2220 TORS THANK YOU 800 - 225.6 or nebs,00m