Claim by Charles PiekenbrockTHE CITY OF
DUBtJE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: August 24, 2010
RE: Claim Against the City of Dubuque by Charles Piekenbrock
Claimant Date of Claim Date of Loss Nature of Claim
Charles Piekenbrock 08/23/10 08/04/10 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
Charles Piekenbrock
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
(-1(
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA L
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: L titaz I€ r e dot �L
2. Address: 1 `h <J 2�
3. Telephone Number: (&) S5Z0 - 8 f D
4. Date of Incident: M / '/ , 20 /0
5. Time of Incident:
8. What were weather conditions like?
6. Location of Incident (Be specific): hie x1- 4-0
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7. DESCR E 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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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?
15. What amount do you claim from the City of Dubuque?
Dated at Dubuque, Iowa this
(Rev. 1/00 & 7/01)
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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.)
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16. Why do you claim the Ci 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.)
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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(Signature)
(Print Name)
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Subject: Claim - Lexus
From: "Brenda Snyder" < Brenda @icapiowa.com>
Date: Tue, 17 Aug 2010 08:50:55 -0500
To: <jrichardson @flexsteel.com>
Good Morning Jim:
Please forward bill once you have rec'd and I will get this taken care of for you.
Thanks, Brenda
Brenda Snyder ( Iowa Communities Assurance Pool
5701 Greendale Road. 1 Johnston, IA 50131E www.icapiowa.com
(T) 515 - 727 -1595 1 (F) 800 - 693 -9610 1 brenda @icapiowa.com
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telephone. Thank you!
of 1 08/17/2010 11:59 AM
Ticket #:
Name'
Year and make of auto:
COMPLETE DETAIL:
INSPECTED
,Miracle Car Wash
255 LOCUST ST.
DUBUQUE, IA 52001
PHONE: (563) 588 -0185
Color:
Date:
TOTAL
TAX
TOTAL
2090 HOLLIDAY DR.
DUBUQUE, IA 52002
PHONE: (563) 557 -7822