Claim by Amy OsterbergerTHE CITY OF
DU MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: November 23, 2010
RE: Claim Against the City of Dubuque by Amy Osterberger
Claimant Date of Claim Date of Loss Nature of Claim
Amy Osterberger 11/22/10 08/31/10 Vehicle Damage
This is a claim in which claimant alleges that as she was exiting the Locust Street
Parking Ramp on Bluff Street, the exit arm prematurely came down on her vehicle,
scratching the hood and quarter panel.
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
Tim Horsfield, Parking Systems Supervisor
Amy Osterberger
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 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.
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: A l ?
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2. Address: 12-56 161,0f , St
3. Telephone Number:
4. Date of Incident: 1 6. ) 1 1
5. Time of Incident: f t) - 1.,
6. Location of Incident (Be specific):
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9. Give name and address of any witnesses:
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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.)
ere w t h e conditions li k e ?
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10. Did police investigate? (If so, give names of o icers.)
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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? kli .2
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. Whatt pt1lo you claim from the City of Dubuque?
10. Why do yop claim the City of DL
Ot VIM ) ifu
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yQ , 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?
Dated at Dubuque, Iowa this ( (01 day of 1 O \IDA lair , 20�,
An4 I.
(Rev. 1 /00 & 7/01)
buque,is responsible?
i -Eke- cu' i Alit_
(Signature)
(Print Name)
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QTY.
MATERIAL USED
PART NO. DESCRIPTION
PRICE
YES
DUBUQUE, IA 52002
563 - 556 -2593
DSS ISJ
LABOR CHARGE
Lubrication ❑
NAME
Jvmv � 5��? - `/6,:x f'�
DATE ,
/
�U -�t 2 0/o
Change Oil ❑
'
Gamv
ADDRESS >
/ : 3 - 5 - // -4/LC $72ee % , 9 4 AX ' .L4 -5'.-Z 0 c /
Change Oil
Filter Cart. ❑
I
_
f Al 1 Co pN 3c
V J `
MAKE
/
TYPE OR MODEL
-j�JPCli'?C'
YEAR
RECEIVED
Change Trans. ❑
c
P M
Change Diff. ❑
SERIAL NO.
ENGINE NO.
_5 V c T
PROMISED A M
P M.
/
1 , /l. •
--I,
J fi t --
pack Front
Wheel Brgs. ❑
2
ODOMETER
r9.q 7 70 O
LICENSE NO.
1 /c3 /4X U
TERMS
PHONE WHEN READY
❑ YES ❑ NO
Adjust Brakes II
Rotate Tires ❑
I
ORDER WRITTEN BY
PHONE 7
.5✓3 -
Wash Polish ❑
OPER NO.
INSTRUCTIONS
State Inspection ❑
���4
il'- 2 � ,I.it 1, f S, // r he{'
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VU
gpit,..... _
�,,.1,s -4 pa,- ,e-e-s ‘_5 t X _5 _,
la
, 773 "IM 7 12 ,.q9.�t 1 ,5 id `x:.,-
/e V gam?
OUTSIDE REPAIRS
/ VOL! u^ .netlr,J , a pnc , •tllr',rte for me er'air -1 yon r .wo;l.nznii Th.• r:oril ! orr- •n, n; -.0 ' .. tt :n .hn , • - it .ate r:L TII n:.t ",.,. , ,r - ' me 3 :J t 'an
roll ;).rna•,Ion vot" siyn,tt,ri3 :l'II ,, d, , a_n Sole,
Tend l, ;:Nn •- : tilr a tc • 1 .n,Iertan, , hat r I , ..I .. tas . i' t, I "^ n,• r., i„ ,
-Y ' ;en�IJl '. t I " { 'nir' � � �i" ,�'I� 1'1�� ,i�n', IE'. (,lll'lil lc ., LF`(:
1. I request an estimate in writing before you begin repairs
BROUGHT FORWARD
2 Please proceed with repairs, but call me before continuing if the pnce will exceed $
3. I do not want an estimate
QTY.
ACCESSORY NO.
t er t i,, '`: t t :i
ACCESSORIES
PRICE
WARRANTY
YES
No
I hereby authorize the Above wax work to Je ,4vy ..lung with the necessary rnatenal. and hereby grant
ate the car or hick myhaa'•,S
you and /or youranoioyeespormswnto r d'
o elsewhere for the pylon.* of teestirrs and ' v ins nnnon An ? xptsss ,nechanr s !w ,s ''t,xeby
u knoslaiged on above car or truck to secure !r e.nrxrunt of npairs tiwreto.
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METHOD OF PAYMENT:
TOTAL LABOR
6 �.? i �Z1
[CASH
TOTAL PARTS
C CHECK
ACCESSORIES
NOT aEr,' "tar3 EL E
'On [ fS, ),
AF.1AUF r` "'
OR AH1i"l E`, ; EFT
IN''A;S'N eSr =
A
OTH EH Tlir_Ft Ufa NA
07N �,{1 I:.',r
?E`r,)htD `VH
30,7;1! -a
GAS, OIL, & GREASE
PRICE
CHARGE
GAS, OIL & GREASE
GALS. GAS @
LABOR:
OUTSIDE REPAIRS
OTS.OIL a
I
LI FLAT RATE
erloot,f
/ /s
< 0 T kr-
LBS. GREASE
{
HOURLY
TAX
3 5 3
TOTAL AcCF''",)tilES
;l,c,. ,,. . -il :rt',,
nBOTH
rOTAL_ 4M0UNT
aaams GT3810/GT3811
w g_ j< ca_ L/51— Oa s Y - 4 7'
K -LINE SALES & SERVICE
5075 PENNSYLVANIA AVE