Claim Waddick, RobertCLAIM 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. 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: Robert Waddick
2. Address: 1610 Lori Ct.
`
3. Telephone Number: (563) 582 7980
4. Date of Incident: Rubbish pickup time between 6:00 & 7:00 - See Paul for date.
5. Time of Incident:
6. Location of Incident (Be specific): 1610 Lori Ct. by mailbox
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.)
I used a bottom rail for my patio doors for a brace to hold up my mail box that I had poured cement around. The following a.m. I went golfing and the brace was in place; when I came hom the brace was gone. Employee admitted taking it thinking it
was trash. Trash can and yello can were 5' from rail brace. Name of employee unknown - ask Paul.
8. What were weather conditions like? Sunny & nice
9. Give name and address of any witnesses: Joan Waddick saw it out there.
10. Did police investigate? (If so, give names of officers.)
No Police- Paul from City Garage sent someone up to take picture of mailbox and patio door.
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
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.)
Paul & I both tried to locate new or used bottom rail to no avail.
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?
$255.58
16. Why do you claim the City of Dubuque is responsible?
See #7
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 4th day of October, 2004.
/s/ Robert Waddick
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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('-;/~. /}f/~~'~:..¿:d'.' pC/,4-;;:/
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA C/ /.A7/{¿'/
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: Robe, t ','caddick
2. Address:
:¡'6:¡'O
Lori Ct.
3. Telephone Number: %3 552-7)20
4. Date of Incident:
i¡J.~ ish pL;;<:L1p ti1e between (:00 & '7:00 - SEe Paul for date
5. Time of Incident:
6. Location of Incident (Be specific): 1 (1 () T.1ri Ct
bv
~i 1 }'n"
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.)
I used a botto~ rail for ~y pa~io doors for a brace to hold UD ~y
~ail box that i had Doured c¿~Ent aro~nd.
The following a.~. I went
Gal fine élLd the brélcc ,,:as in place; when I cane ho,ne t'lC brace ';lélS gone.
t.nplo:¿:ee aa.ntt~d tarang ;¡,t, C¡ar,}ang It "as trash. Trash c'm & yello'ii can
8. Wh~1r;erê' w~~rlÎ'krrgÓ-~di~r¿'iiseI1k~~'Je g£nf1:pP~Rdef1i b'~::nown - ask Fa ul.
9. Give name and address of any witnesses:
Joan Waddick saY! it out tI;ere
10. )id poli~e inyestigate? (If,so, give names of officers.)
No ,'01lse-Paul fro] clty Eara¿,e sent so:neone 11:) to cake '01 ct~rs ofnailbox
&¡Jö.LluduUl. . .
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
];0
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.)
Palll and I both trieÖ. to locate new or used bottom rail to no avail.
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?
$255.58
16. Why do you claim the City of Dubuque is responsible? See #7
/
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
f
day of (J- &te.vv
,20ll.
~ ØY ~ ~~4~~ ~,
(Signature)
R [) bÞ/y-r WAde;;! Ic--I-\
(Print Name)
(Rev. 1/00 & 7/01)
5300 Dodge St.
Dubuque, IA 52003
Phone: (563) 556-5222
Fax: (563) 556-2743
Store# 3057
Store ID: DUBQ
LARSON ESTIMATE
10/05/2004
PAGE 1
JOB NUMBER: XXXX9999
~
ESTIMATE FOR:
Menards Team Member:
QTY/DESCRIPTION
LIST
PRICE
EXTENDED
PRICE
----------------
---------------------
1
SKU # 400-0569 $255.58 $255.58
L82 STORM DOOR/Tip-To-Tip SIZE: 7l-l/4"W x 79 2-PANEL PATIO STORM DOOR
White / Maintenance-free heavy-duty extruded frame
Interlocking door panels are constructed of tempered SAF-T-GLASS ~
Wrap around marine glazing and double-weatherstripped f ~
Inserts operate smoothly on adjustable ball bearing rollers -----------
Door Kit Included
Screen not available
(7. f9
~/-J
275.Lf'¡
GRAND TOTAL (WITHOUT TAX) :*$255.58*
**SALE PRICES VALID THROUGH MONDAY, 18 OCTOBER 2004**
~~i~~se~n,~:ti;.~:~~t ~~~~de~;~~ t\:'¡~ g:.:'tr.:,a~t~~i~~nf°ri~~I~t~t~~i~~~~I~t:::. O~~bj:~~tt~'::'~.",;';eb~e~~~eJj~~ ~~~I~~eC~~;~~:
conditions, The prices stated on this estimate are not Rrm for an~ tima &erlod unlass 'i!'ceclflcel~ written otherwise on this form.
i~Ê t:'~~ ~~~Ë ~ W'ti'òeÁi~~~ssð~~r:I¡:~~~eÉ'iF'6~~~~~'R'Jf¡J"o~~ T~~SA ~~TL~'¡¡~ LI~~~ kN~g~ ~~l ~~i~ ~~..fL~ RS~ ~~Ó
HEREIN. All Information on this form, other than price, has been provided by customar and Menards is not recponsible for any
:~ì'.;,sa¡~ ~~~~r~l~r~~t~'N'AR'D~h~:~~~~'ö i~~I~~~M~tTIh:\~it~WL~~H¡UE~i~e¡\'~T~~~~~~lIm:¡e~~Ê e~¡~~n¡\',l~~
LISTED ARE surf ABLE FOR ANY PURPOSE BEING CONSIDERED BY THE CUSTOMER, BECAUSE OF WIDE VARIATIONS IN
CODES, THERE ARE NO REPRESENTATIONS THAT THE MATERIALS LISTED HEREIN MEET YOUR CODE REQUIREMENTS,
.
No charge for labor to re:nove old doors and insv.ll new door ad
take doors to dùmp.
Note - sale prices good through Aon. 18 Oct. 2004.
If need be I'll
pay for it ~hen you can send TIe the check, but I'll need a tax
deferred n~mber.
I called Paul the norning of this incident hoping 8o~eone ~ight find
the alu:1inuc.1 bottom rail.
ð3~ f}Y~
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