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Claim Kennedy Mall KENNED Y MALL L TD . An Ohio Limited Liability Co. www.kennedvrna11.com / operations@kennedymal1.com May 13. 2004 City Clerk City o.f~ 95 W. 13th Street Du~. rowa52ØfH-33tt2 De1:!r City C~ EncWsed ¡sa "CI_Against 1'heCity ofDnbuque;Jawa" futm. AU of the infarmatiû:ntlmt j'0U!~sbmRd. beioolmtedŒl the fœm.. If you have any questùms ør-require.additiomd ÌIlfm'matÌtm. feel free to contact ~<!i 556- I 994. Sineerely. ~9-~ DougL~ Property .~ DJS!djs 5551o1mK~~~~52002 Phone:( 563} 556-1~ F-:t:56:l)556- ~ 'V a .¡c- 5?: -( --.J ,""," .. CLAIM AGAINST THE CITY OF DUBUaUEj'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. 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: Kennedy Mall 2. Address: 555 John F. Kennedy Road, Dubuque, Iowa 52002 3. Telephone Number: (563) 556-1994 4. Date of Incident: N/A 5. Time of Incident: N/A The city bus stop in front of The Dubuque 6. Location of Incident (Be specific): Mining Company at Kennedy Mall. 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.) - The city buses have rippled and buckled the asphalt at the bus stop due to the buses stopping and sitting on the asphalt. The uneven surface poses a potential tripping hazard for mall patrons. 8. What were weather conditions like? N/A 9. Give name and address of any witnesses: N/A 10. Did police investigate? (If so, give names of officers.) N/A 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). Several people have reported the damaged condition of the asphalt. There have been claims filed in the past due to the uneven surface. 12. Was any damage done to property? (If so, describe property and the extent of damagés. Attach estimates of damages or describe basis for ascertaining extent of damage.) A 13 fDot by 100 foot area of asphalt at the bus stop is rippled and buckled. 13. What other damages do you claim, if any? Only the damage to the asphalt. 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? 100% of the replacement of the asphalt which was damaged. The amount should be equal to the damaged asphalt area (13' x 100') to be replaced by reinforced concrete. 16. Why do you claim the City of Dubuque is responsible? The damage was caused by the continual daily traffic of the city buses picking up and dropping off, riders. The excessive weight of the buses is the main contributing factor to the asphalt damage. See attached site plan and photos. 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) No. 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 ¡ .~ day of .1'1 '" y ,20~. ¿Q ~ -4-L.~ U ignature) ,ovUG. 7' S<-ilA:6 tllé?e. (Print Name) (Rev. 1/00 & 7/01) BrSHOP'S REST. d // ,.// "'" ~ "--, "", "': "--,,-: "', "--'- "--'" /./ / I I ~ II I -!t ./ // -~ DuBuQv6 MINJA/& LO ..-.. ~ ~ " '" D-- >-Gl ~~ ~~ ~ "--'" ~-"'--- "--, ~- ~'-< ~,"--" -~ ' ~ <:: '~ '", ~." . / / ./ ./ ../ ".// ,/// / //./ '~ ~ "--, ~""'- "--" "'--" ~ ~~ ~,"--" ~-~ ',,-- '~ ~. "-'" ,/' '-, /./ //120"" ,/ PARKIN // SPACES "" SERVICE COURT #+ r-- - ~s. ~O"Té - c::::: ~ ~ ~ ~ // '~ ///' 0... / ,/221 ~ / PARKING / .sP ACES-. ./ -', ....--- '--. ./ ' / '" ./ / ....--- // / ././ /././ ./' ./ /....---./ /.// / / / .// /' '-',,-- ",,-- ~'" " ,/ ~ -~ ./""---....---/ // //./ /....---/ '-- ./ / FU'I / ./ "-, '"