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Claim by Daniel Stark
Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL iJ-D. To: Mayor Roy D. Buol and Members of the City Council cc: Michael C. Van Milligen, City Manager Paul Schultz, Resource Management Coordinator Daniel Stark MEMORANDUM DATE: November 9, 2010 RE: Claim Against the City of Dubuque by Daniel Stark Claimant Date of Claim Date of Loss Nature of Claim Daniel Stark 11/01/10 10/24/10 Vehicle Damage This is a claim in which claimant alleges that a City of Dubuque refuse truck backed into claimant's vehicle as claimant was attempting to pass the refuse truck near 2153 Hale Street. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. 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 l /ice' 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 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. 1. Name of Claimant: bnn le I 5-6'(1 S153 Rle 2. Address: bP Q It\ 5,)onl 3. Telephone Number: q/5 - - v <gc/-i 4. Date of Incident: / d /9 / 0 5. Time of Incident: 07 OS A rv\ NQ. 001: )0.00 LQnvie�tst+, ‹at--)0% CPO 940 6. Location of Incident (Be specific): 5 Me 1 (eF 9. Give name and address of any witnesses: P)(UN L0c9e 10. Did police investigate? (If so, give names of officers.) yPS . ' { : KRA yeti Rod 1 �A 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). 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. 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.) E m4le\ flQn ?; f Qnie1 R obert Starkey The qar v --ruck was pocked in tl- cFItttC eP street. I went poss him avnck rwec\ pss \ 'Avg, \ o (A N)eV cctS (AM v\ r1\ ve_h ■C \e. wC5 "© \r" C4' \0i\ 0) 0 1 Lek bE (`4\ 0_4ecse. CI ►ifs 815Aq/550 ,.n1) 8. What were weather conditiolis HMI? LV a/53 Nale siree4 b buc o, /A i oc t 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.) d\- \\Z_ Lluq) 4a( N(Ne( 460 read bc.tolbu. Y1as bf e (� P�1fi Quci nCth tS. rSt\Q - Qoc kbca 0<ub 94c6.0, cMoav , Q\ cell O. pci 13. What other damages do you claim, if any? AJnop 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.) )Vc�, 15. What amount do you claim fro ES -Ii-a }e Is a tiGchod the City of Dubuque? 1 ()3 16. Why do you claim the City of Dubuque is responsible? gC\dbalA. Atuek c\tkge( ■1 \(\\) coat - C' Ity \ION'ke ()Jo nok 04p(se and wi ((■6\co -Vofn icA bocK■n c,�_ I�g11tg,9nals, n(50-0 ' 17. Have you made any claim against anyon & else for damages as a result of this incident? (If yes give name and address.) IVY 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in mvhat amount? N/ y Dated at Dubuque, Iowa this Pi- day of NNW c ( , 2010 . (Rev. 1/00 & 7/01) ))011;P/ Sta�k (Signature) (Print Name) n VII ertngno ZO:Z b!d I - AONOl Cie /11i028 10/28/2010 at 03:17 PM 24443 Insured: Owner: Address: Evening: Inspect ABRA - DUBUQUE Location: 3400 CENTER GROVE DR DUBUQUE, IA 52003 Insurance - Company: 2008 HYUN ELANTRA SE 4- 2.0L -FI 4D SED BLUE Int:GREY VIN: KMHDU46D88U303860 Lic: 146588 TX Prod Date: Air Conditioning Rear Defogger Cruise Control Telescopic Wheel Keyless Entry Steering Wheel Controls Dual Mirrors Console /Storage Stability Control Fog Lamps Power Steering Power Locks AM Radio Search /Seek Anti -Lock Brakes (4) Head /Curtain Air Bags Cloth Seats Overdrive NO. OP. 1 2* 3 4 5 6 7 8* DANIEL STARK 2000 UNIVERSITY AVE DUBUQUE, IA 52001 (915)667 -2204 Rpr R &I Rpr REAR BUMPER Bumper cover Add for Clear Coat O/H bumper assy REAR LAMPS LT Tail lamp assy QUARTER PANEL LT Quarter pnl assy ant ABRA - DUBUQUE Federal ID #:420782245 DBA: ANDERSON -WEBER INC 3400 CENTER GROVE DR DUBUQUE, IA 52003 (563)556 -0696 Fax: (563)556 -1899 PRELIMINARY ESTIMATE Written By: RICK KELLY Adjuster: Power Brakes Power Mirrors FM Radio CD Player Driver Air Bag Front Side Impact Air Bag Bucket Seats Aluminum /Alloy Wheels DESCRIPTION 0 w/o glass 0 1 Claim # Policy # Deductible: Date of Loss: Type of LOSS: Point of Impact: Job Number: Business: (563)556 -0696 0 0 0 Days to Repair 08/2007 Odometer: 34413 Tilt Wheel Intermittent Wipers Tinted Glass Traction Control Clear Coat Paint Power Windows Heated Mirrors Stereo Auxiliary Audio Connectio Passenger Air Bag 4 Wheel Disc Brakes 5 Speed Transmission QTY EXT. PRICE LABOR PAINT 0.00 0.00 0.00 0.00 0.00 1.0 0.0 1.6 2.8 1.1 0.0 0.4 0.0 5.5 2.0 10/28/2010 at 03:17 PM 24443 PRELIMINARY ESTIMATE 2008 HYUN ELANTRA SE 4- 2.0L -FI 4D SED BLUE Int:GREY CCC Pathways - A product of CCC Information Services Inc. 3 Job Number: 11/1/2010 Gogle maps Get Directions My Maps hale str dubuque iowa - Google Maps Print Send Link maps.google.com /maps ?hl =en &tab =wl 1/2