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Claim by Mark and Kim TranelTHE CITY OF DUB TE MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL )J„L. To: Mayor Roy D. Buol and Members of the City Council DATE: October 4, 2010 RE: Claim Against the City of Dubuque by Mark & Kim Tranel Claimant Date of Claim Date of Loss Nature of Claim Mark & Kim Tranel 10/04/10 07/22/10 Property Damage This is a claim in which claimant alleges that a City tree was blown over during the July 22, 2010 storm and damaged claimant's mailbox. 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 Marie Ware, Leisure Services Manager Mark & Kim Tranel 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 b 'i/'1 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 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. 1. Name of Claimant: 1•11/) 2. Address: 15 7:3 a-ll'iTe,)2_ci at, 3. Telephone Number 5 (03 - S9 / 7 702_ /5 Co 3 - eo -5 6Q/ 4. Date of Incident: 7 - .2a- ( 0 5. Time of Incident: 9./5 j c/ 6. Location of Incident (Be specific): 1 73 Cl i`f-Fo r dub t “. 6 -2 -° 09- 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.) u )o I Ic N- tJ C-u b u>cL to to i a v t `� 1 ►L cl S 'E O Q VV� CSM A� ! O ICJL� O - F - t �-- j' r o 8. What were weather conditions like? W r ►2oI 9. Give name and address of any witnesses: k CI i ,� rc-1 10. D ® police investigate? (If so, give names of officers.) 7-ane--/ 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). AJ O 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.) y 0 rn.D..; 1 b oX was bex). 5 Pr A— l�Vt� C( r o 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.) o 15. What amount do you claim from the City of Dubuque? 15. t03• / 16. Why do you claim the City of Dubuque is responsible? rt`I�sZ b ro k D 0-f e_ wo * / boy ti.) as-) o\ 0) 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) )O 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 day of , 20 / ©. 0 0 C7` c M tn v, /0_4r, cC -' rn (Signature) . - ; — Ki //0 re_a_ /714 yO o ril (Print Name) D 0 cm QUANTITY ORDERED QUANTITY SHIPPED LOCATION ITEM NUMBER DESCRIPTION UNIT EXT/ UM UNIT PRICE EXTENDED PRICE DATE DELIVERED .i :.. . : `, BY RECEIVED G X T NET SALE TAXABLE SALE TAX % TAX TOTAL DELIVERED BY LOADED BY CHECKED BY X S 0 L D T 0 SELLING ._._. STORE ACCOUNT SHIPPING SALES STORE PERSON S H P T 0 OUR ORDER DATE CUST. P.O. CUSTOMER COPY TERMS OF SALE • All charge purchases are due for payment as indicated by the invoice due date. This method of billing is offered as a convenience for all charge purchases made during the previous month. This credit is not a monthly payment plan or a revolving type credit plan. • All product returns must be made within 60 days from original sale and must be accompanied by a sales receipt. • While a FINANCE CHARGE is added to your account if the balance is not paid by the invoice due date, such extensions of credit are not encouraged. To avoid FINANCE CHARGES and tc comply with the ProBuild credit policy, your balance must be paid in full by the invoice due date. • FINANCE CHARGES are computed by a periodic rate of 11/2% % per month which is an ANNUAL PERCENTAGE RATE of 18 %. • The FINANCE CHARGE will be assessed on any past due unpaid balance after deduction of current payments, credits and allowances. The minimum monthly FINANCE CHARGE is $ .50.