Claim by Cyndi HarkerTHE CITY OF
DUB TE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
isp
To: Mayor Roy D. Buol and
Members of the City Council
DATE: September 21, 2010
RE: Claim Against the City of Dubuque by Cyndi Harker
Claimant Date of Claim Date of Loss Nature of Claim
Cyndi Harker 09/17/10 09/15/10 Property Damage
This is a claim in which claimant alleges that police had to use forced entry in order to
gain access to claimant's rental property at 1010 Rhomberg.
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
Mark Dalsing, Chief of Police
Cyndi Harker
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.
1. Name of Claimant: C
4. Date of Incident: (`,q 1 j 1(i
2. Address: C — I L,\ca
3. Telephone Number: ( (;P) 7 - I U
5. Time of Incident: I \iv■ey. 10
10. Did police investigate? (If so, give names of officers.)
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6. Location of Incident (Be specific): 1 l C Q. h i✓m9, t � � IP1
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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 the employee's name.)
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8. What were weather conditions like? S U,ti�,,. , ., ` C (x c C.X '∎ ,t-\_,c),/x
9. Give name and address of any witnesses: K ,:,r„ De gyp A *-X1 D itAINA *Jr j LkXLO i �s
. J, LLB., 1
11. Was anyone injured? (If so, give names, addresses, and extent of injuries.)
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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? N
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? % H (c I 1
( c # c C n - , t ,max x,-1 C v . (' c z
16. Why do you claim the City of Dubuque is responsible? i (7. A, i ALA
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?
Dated this j l dh day of S e.p1"3,'m -Q14'A
I hd 4 *an )t2J, )
(Signature)
Cy Ki H t ER
(Print Name)
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Use Your
BIG CARD
f
2%
REBATE
MENARDS — DUBUQUE
5300 Dodge Street
Dubuque, IA 52003
KEEP YOUR RECEIPT
RETURN POLICY VARIES BY PRODUCT TYPE
Unless noted below allowable returns for
items on this receipt will be in the form
of an in store credit voucher if the
return is done after 12/15/10
11111111111111111111111111111111111111111111
E -1 6 -PANEL STEEL DO
4141677
1" X 4" SPEEDBOR BIT
2423437
SCREW ALL PURPOSE 3"
2292874
SUPER 160 DOOR VIEWE
2210191
SN COMBO GEORGIAN /DB
2196680
1X6X8' SELECT BOARD
1031722 2 @12.92
1X6- 71 -72" SELECT BO
1031719
Sale Transaction
TOTAL 235.27
TAX AT 7% 16.47
TOTAL SALE 251.74
CASH 300.00
CHANGE 48.26-
TOTAL SAVINGS 0.49
TOTAL NUMBER OF ITEMS = 8
THANK YOU, YOUR CASHIER, DALE
7470 07 4967 09/16/10 10:43AM 3057
139.00
3.97
2.29
4.76
49.92
25.84
9.49
Houp Construction LLC
905 Kelly Lane
Dubuque IA 52001
(563) 581 -6085
To:
Cyndi Harker
1010 Rhomberg
Dubuque, IA 52001
I emu
BILLING INVOICE 09/16/2010
6 0 9 J 1 - 7 / , ')C 10
✓# 15 II
Removal of damaged door, trim, extension jambs
Disposal
Install new E -1 6 -Panel Steel Door
Install new dead bold and door knob
Install new extension jambs
Install new trim.
Caulk and paint.
Misc: trim nails, insulation
Material $251.74
Misc material::trim nails, caulk, insulation
Trim cartridge $25.00
Disposal Fee $15.00
Labor $170.00
Total Due: $461.74
Memo t2`: e ' k - I/ i I
4444444444644
ULAN
DEPOSIT
FORD
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09 J t 'I A L .
FORD
ITEM
AMOUNT
TAX DEDUCTIBLE ITEM.*
1514
NOT NEGOTIABLE
i
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