Claim University of Dubuque CLAIM AGAINST THE CITY OF DUBUQU,
This written report constitutes'your claim against the City of Dubuque, Iowa. You sl~ould
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. 13th 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: University of Dubuque
2000 University Avenue Dubuque IA 52001
2. Address:
university of Dubuque
University Avenue Dubuque, IA 52001
3. Telephone Number: 589 3710
4. Date of Incident: 8/8/03
589-3710
8/8/03
APPROX 8:00 a.m.
5. Time of Incident:
6. Location of Incident (Be specific):
1760 Overview Ct.
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.) ·
A City of Dubuque recycling truck d~ove over
13 feet of a 1'4"~ wide 2'6" high stone wall at the north east
corner of the property
8. What were weather conditions like? Clear & sunny
9. Give name and address of any witnesses: Bio
10. Did police investigate? (If so, give names of officers.)
No
11. Was anyone injured? (if so, give names, addresses, and extent of injuries).
Bio
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.)
Yes, 13 feet of the 1'4" wide 2'6" tall stone wall was
broken so that it had to be replaced (See photos) 12 paver
bricks along adjacent driveway also had to be reset
13. What other damages do you claim, if any?. None
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.)
No
15. What amount do you claim from the City of Dubuque? $9oo. 00
16. Why do you claim the City of Dubuque is responsible? The driver of the
recycling truck was a city employee conducting city business when
he drove onto the property and drove over the wall.
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 at Dubuque, Iowa this 2nd day of September, 2003.
(Signature) /s/ Alan L. Burr
(Print Name)
(Rev. 1/00 & 7/01)
Dan Becker LandscaPing
2160 EIm St
Dubuque, lA.
52001
Bill To: Ship To:
University of Dubuque
2000 University Ay
Dubuque, IA 52001
invoice
Number: 1002
Date: August 19, 2003
Customer # Project
2 overveiw ct.
Description Quantity PAce i Tax Amount
repair wall - damaged by city truck 1.00 900.00 900.00
[
[
Sub-Total $900.00
State Tax 7.00% on 0,00 0. O0
Total $900. O0
0 - 30 days 31 - 60 days 61 - 90 days > 90 days Total
$900. oo $0. oo $0.00 $0.00 $900.00