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Claim by Gary and Joan Miller
Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL To: Mayor Roy D. Buol and Members of the City Council cc: Michael C. Van Milligen, City Manager Marie Ware, Leisure Services Manager Gary & Joan Miller MEMORANDUM DATE: August 26, 2010 RE: Claim Against the City of Dubuque by Gary & Joan Miller Claimant Date of Claim Date of Loss Nature of Claim Gary & Joan Miller 08/25/10 07/22/10 Property Damage This is a claim in which claimants allege that a city tree fell on claimants' house during a storm that occurred on July 22, 2010. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. 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 Attorneys 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. C,i3Q 1. Name of Claimant: 7 * 1(7/i� M / L. LE lam. /1 2. Address: a 3?2 JROSFMcA) . ? VdA7}Qd& .174 S-2o ' J 3. Telephone Number: 4. Date of Incident: 5. Time of Incident: � <03'3 - 3'6 - '74R' ft PPRO X . S' o 6. Location of Incident (Be specific) Nf ;R/ OcRAlcf:. OF HILL C, Es l '4- 8cseMaAI S4. f} T 60s STOP) - NDRTH sine, ccp Louse. 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.) A c 1 y - 1Ze c, �1 l I 010 .:1 R 1 Gy S e_ 8. What were weather conditions like? .S - I - c R 9. Give name and address of any witnesses: SQ-e P I CA ( e-S 10. Did police investigate? (If so, give names of officers.) Th., y rc for' -4-e i i - 17) L,sti e SeRViCeS 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.) £ H,iUGLES — 07 M/I GED j 0d77 — c C k c) ,Z4 R77--/ it) D o Ai s e A /4 v Ffa/f/j Hdd Ri v/47 F. i2ee Di9A4Ft ( F t) AV F7 LL o P tvM L ,eLL 13. What other damages do you claim, if any? WilEN - "✓ee- r Mo'e -e 5 ; cle cc oL K 5 Ial 5 Pr Ree UNF, UEll) mg-7 Poo,c.S 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? -S' !D 7 3' 79 d se Da i12a5 Q- -Jo be, del 1 /6 " clq z I / ✓cJ€ -ire s t c/etva.l K (e pla ea) 16. Why do you claim the City of Dubuque is responsible? /06 % BNJ�/ (d d ►`�� atilia �. Si ti)cr.(+ Jit1 a. © ( Ci IX C codtta j - oor home, -1-Yee.. 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) x) 0 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? Dated this o4 day of (Print Name) C-MA' Joh M/LLFk ,20 Estimate Section: Roof Quantity Description Unit Cost RCV DEP ACV 52.0 LF 1.0 MC 17.0 LF 1.0 EA Remove and Replace Aluminum Gutters Minimum Charge Composition Shingles ++ Remove and Replace Drip Edge for Composition Shingles ++ Per Pick -up Truck Load Hauling $6.41 $208.65 $2.46 $90.00 $333.32 $208.65 $41.82 $90.00 $333.32 $208.65 $41.82 $90.00 Totals For Roof $673.79 $0.00 $673.79 Repair Item Totals $673.79 5673.79 l /,s »s coP V o F - 5 TA M/ & £ Y nb FFRoM o 02 /V5O, xk eg, 1161/7 . &c,ose, o 0 Ado b (c We- is e, core eA)sier i eC� w;11 NOT INSURED : Gary Miller LOCATION : 2098 Rosemont : Dubuque, IA 52002 COMPANY DATE OF REPORT : 8/3/2010 DATE OF LOSS : 7/22/2010 POLICY NUMBER : 731 93 11 CLAIM NUMBER : 5000139931 OUR FILE NUMBER : 731 93 11 ADJUSTER NAME : -s4 A4 1 01; 111 . 1 30 • _ :.;