Claim Bartolotta, MichaelCLAIM 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: Michael Bartelotta
2. Address: 1790 Grace St., Dubuque, IA 52001
3. Telephone Number: (563) 582 7812
4. Date of Incident: May 15th, 2003.
5. Time of Incident: Unknown
6. Location of Incident (Be specific):
Near the corner of Bennett and....
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.)
Grace St. was to be No Parking on May 14th & 15th due to Asphalt Paving so we were supposed to move our cars. I moved my car to a parallel street, Bennett St., but it was towed from there because they were receiving asphalt paving also.
Citizens on Grace were not informed of this.
8. What were weather conditions like? Sunny, 60's - 70's
9. Give name and address of any witnesses: N/A
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
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.)
No
13. What other damages do you claim, if any?
N/A
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.)
N/A
15. What amount do you claim from the City of Dubuque?
$148.40
16. Why do you claim the City of Dubuque is responsible?
Because I was not informed that the surrounding area was receiving the same street repairs,
and that my car would be removed from that street for the same reasons.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
N/A
Dated at Dubuque, Iowa this 3 day of June, , 2003.
s Michael Bartolotta
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM .AGAINST TH. E ClT. Y OF DUBUQUE;4OWA ' ~
This writte.n report constitutes your claim against the City of Dubuque, Iowa. You shou!~l
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: j[[,~,'l J~=/="~
2. Address: I?~/c~ C~,-~ S~ /gM~u~ .~
3. Telephone Number: (~5_~ 5-~-~-?¢l;g
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
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
emp. loyee's name.) lq
8. What were weather conditions hke? ~,/
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
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.)
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If ye~,, give name and address.)
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, iJn what amount?
Dated at Dubuque, Iowa this
day of ."~ , 20 e.~ .
(Sig nature)
(Print Name)
(Rev. 1/00 & 7/01)
We're giving your street
the once over,..
and then some.
NO STREET PARKING
7 a.m. - 3 p.m.
Where:
Who: ~ '~-~
How: ~ con--re S~on Repai~
~ ~alt S~on Repai~
~pha~ Pa~
(s~ ~her ~de ~r d~lk~
Another service of the City of Dubuque.
The Dubuque Operations & Maintenance Depart~nent
wants to keep your street and all of the thoroughfares
in Dubuque well maintained and Jn a state of good
repair. To accomplish that goal, we routinely evaluate
the condition of each s~et in the city. ,~,fter careft~
e)amination, we determine what, if any, maintenance
must be performed.
Our knowledgeable and courteous team of City
employees will perform the necessary maintenance
work with little inconvenience to you.
On the day of the scheduled work, please follow all
directions and traffic control devices within the
maintenance area (remoVing your car from "No
Parking" areas and refraining from driving on the street
until after the work is finished).
We are committed to crea6ng a better quality ride for
those who live and work in Dubuque. Please help us
help you.
Thankyou foryourcooperation.
Operations and Maintenance Dept.
(563) 589-4250
!.c. RCa.
563-556-648024'H°ur Towing Service ,--___________d
275 Salina St. Dubuque, IA 52003
Fa.x. 563-556-30:15
=ervlce
MasterCard & Visa Accepted
STATE ZiP
YEAR, MAK. Fv~ODEL . j / ~ /' CQI.4~R ~1~
~ILEAGE
FINISH
START
TOTAL
REASON FOR TOW
[] ACCIDENT
[] ARREST
[] UNREGISTERED
~¢'~OW ZONE
[] SNOW REMOVAL
[]ABANDONED
[]STOLEN CAR
•BREAK DOWN
•LOCK OLF~
•START
[] FLAT TIRE
[] OUT OF GAS
[] IMPOUNDED
EXTRA PERSON
FINISH
START
TOTAL
SPECIAL EQUIPMENT
[] SINGLE LINE WINCHING
[] DUAL LINE WINCHING
[] SNATCH BLOCKS
[] SCOTCH BLOCKS
[] DOLLY
TYPE OF TOW
[] SLING/HOIST TOW
[] FLAT BED/RAMP
HEEL LIFT
STORAGE FROM
TOWED PER ORDER OF
[] STATE POLICE
LOCAL POLICE
OWNER
[] DEALER
TO __ DAYS @ $
PAID BY
DRIVERS
[] CASH [] CHECK MC. NO.
[] CREDIT CARD [] MC
EXP.
[] VISA [] AMEX DATE
CC NO.
AUT~R~'ED SIGNATURE ' DATE
VEHICLE RELEASED TO DATE
VEHICLE TOWED TO
TOWING CHARGE
MILEAGE CHARGE
EXTRA PERSON
SPECIAL
EQUIPMENT
LABOR CHARGE
~di/-STO~AGE i
SUB-TOTAL
TAX
TOTAL
17 5 2 8Not responsible forloss or dam~tge ,o vehicle Thank You
in case of fire, theft or any other cause beyond our control