Claim by Gary SchlichtmannTHE CITY OF
DUB UE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
/043
To: Mayor Roy D. Buol and
Members of the City Council
DATE: August 18, 2010
RE: Claim Against the City of Dubuque by Gary Schlichtmann
Claimant Date of Claim Date of Loss Nature of Claim
Gary Schlichtmann 08/17/10 08/07/10 Property Damage
This is a claim in which claimant that the entry doors to his business were damaged
when the Fire Department forced the doors open after being alerted that smoke was
coming from the inside of the building.
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
Dan Brown, Fire Chief
Gary Schlichtmann
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
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA il
This written report constitutes your claim against the City of Dubuque, Iowa. You ' Va
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 Attorney'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.
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1. Name of Claimant: C c et
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2. Address: O W S 'j n� +G n S �
3. Telephone Number -' T 72
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4. Date of Incident:
5. Time of Incident: 4Co v n ) . 3 6 0 f1
6. Location of Incident specific):
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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
th employee's name.) L
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8. What were weather conditions like?
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9. Give name an Address of any witnes es:
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10. Diftpolice investigate? (If so, give names of officers.)
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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 dam age.) (l
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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.) n r
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15. What amount do you claim from the City of Dubuque? i
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16. Why do you claim the City of Dubuque is responsible? l 1
01yvN ; n rr�� Pn-� r9 nce c oar'Y +0 check �T
t1� �, ,V �Y(1GS; ,1 Q -4 re_ rely hv sS.
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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.)
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18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount? C) e
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ZEPHYR
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ALUMINUM
665 Huff Strew
DUBUQUE, IOWA
(563) 689.2038 •
FAX (563)
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PRODUCTS, INC.
PO. Sox 930
52004.0938
(900) 747.9397
5964355
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CID STA1'T7EE AND ZIP 0 .
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*RCr117eer
DATE OF PLANS
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We nareoy siihmii spec.if c Lion and estimates Or
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Mlle Pr0pO a rirsrakty lc furnish meatetiel and labor — cornplate in accordance with above specifications, fur the &:1m at
dollars ($
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Payment to ta0 made 04 follows'
acttptnnte of Jropo8tf1- - The above prices, speatllaetiorn{ and
conalltons aro settateesory end pro thirsty accewarl Ythl a.a teuthoii ed 10 cm the 5ianeture
secs as opacifed. Payment wit be rrted, to Wtlinal above.
Date of Acceptance
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