Claim by Tom BaldwinTHE CITY OF
DUTJE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: August 26, 2010
RE: Claim Against the City of Dubuque by Tom Baldwin
Claimant Date of Claim Date of Loss Nature of Claim
Tom Baldwin 08/25/10 07/28/10 — 08/12/10 Vehicle Damage
This is a claim in which claimant alleges that his vehicle was sprayed with paint during
the painting of the Flexsteel Aircraft Hanger.
This claim has been referred to Airport Operations /Maintenance Supervisor Todd Dalsing
of the Dubuque Regional Airport.
cc: Michael C. Van Milligen, City Manager
Airport Operations /Maintenance Supervisor Todd Dalsing
Tom Baldwin
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
Ic M V 14
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA \/ 1)0 Occ '
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. 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: (31A4 1 LOW ! ,D
2. Address: 2,S< r- w Lnwonri ; Du Au. . :L h s2 on I
3. Telephone Number: ` 3 - s g - 5 2 w y
4. Date of Incident:
5. Time of Incident:
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6. Location of Incident (Be specific): Dsq Anapote.r — F' Ll=x b f -v L la;ao
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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 weather conditions like?
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).
Aro
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.)
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13. What other damages do you claim, if any? NCc
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?
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.)
No
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 2,O day of Au usr , 20 lo .
Io►M
(Rev. 1/00 & 7/01)
(Signature)
(Print Name)
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Phone Number:
Exterior Services
Detail Packages
Meguair's Ultimate Detail $249.99
Complete Detail $99.99
Ultimate Interior $69.99
Superior Detail $54.99
Oversize Charges $
Other Charges $
Total $ /39: 09
[ CSA#:
SIMONIZ EXPRESS DETAIL & RECONDITIONING
3199 University Ave, Dubuque, la * 52001 * (563)583 -6416
License Plate Number: /03 2_ LX Vehicle Year: f
Name: Vehicle Make: G�
Address: Vehicle Model:
City: Date: g" ZO
State:
Meguiar's Express Wax $39.99
Meguiar's Carnuba Wax $49.99
Meguiar's Synthetic Sealant Wax $59.99
2C Exterior Clay, Compound & Wax $119.99
Black Trim & Tire Revitalizer $9.99
Vinyl Top Dressing $19.99
Window Water Repellent $9.99
Exterior Hand Wash $29.99
Tar Removal $
Oversize Charges $
Other Charges $ /!7 Oo
Please Do Not Write Below This Line
Interior Services
Super Clean $34.99
Carpet Shampoo $29.99
Upholstery Shampoo $29.99
Leather Cleaning /Cond. $29.99
Fabric Protectant $29.99
Oversize Charges $
Other Charges $
Additional charges apply to oversize vehicles and
when the condition of the vehicle warrants it.
Technician Remarks
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