Claim Dubuque Internal Medicinecc: MVM, Legal Transit
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. 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: Dubuque Internal Medicine
2. Address: 1515 Delhi St. Dubuque, Iowa 52001
3. Telephone Number: 557-9111
4. Date of Incident: 9/13/04
5. Time of Incident: about 7:30 AM
6. Location of Incident (Be specific): at main entrance (facing Delhi St.)
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 Keyline Project Concern bus, drive by Larry Maule, drove underneath our canopy causing
damage to on the underneath side and the face of the canopy.
8. What were weather conditions like? N/A
9. Give name and address of any witnesses: None - driver reported the damage
10. Did police investigate? (If so, give names of officers.) no
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.) The roof of the bus caused
the drywall to break and it pushed the ceiling upward. Canopy sustained structural damage also. One of the light
fixtures is also damaged.
13. What other damages do you claim, if any? None that are evident at this time.
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? $1,987.00
16. Why do you claim the City of Dubuque is responsible? Driver admitted doing the damage.
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 22 day of September, 2004.
/s/ Michael J. Berg, COO
(Rev. 1/00 & 7/01)
Klauer Construction Company
2755 Dodge Street
Dubuque, IA 52003
Phone (563) 588-0247 Fax (563) 588-0370
NAME ADDRESS
Dubuque Internal Medicine PC
Attn: Leddy Bastian
1515 Delhi St
Dubuque, IA 52001
PROPOSAL
#1471
DATE
10/18/2004
PROJECT, PROJECT NUMBER, DATE OF PLANS, BID DUE DATE
Canopy Repair 2004, KCC# 04082.00, NA, 10/18/2004
WE PROPOSE TO:
FURNISH ALL NECESSARY LABOR, MATERIAL AND EQUIPMENT TO COMPLETE THE FOLLOWING
AREAS OF CONSTRUCTION AS SPECIFIED.
CANOPY REPAIR: Demolition of damaged area of alwnimnn tàcia panel and associated trim, drywall soffit 1,987,00
(approx. 100 sq. ft. area), and damaged can light escution. Transportation and disposal of all related debris,
Install alwninwn tàcia panel and associated trim pieces, caulk & seal. Installation of sheetrock at soffit area, tape,
finish and paint entire soffit, provide and install replacement canlight escution,
NOTE: It appears as though some structural damage above the soffit may be present. A minimal labor and
material allowance has been included for minor structural repairs that may be present above the sheetrock soffit.
This damage cannot be ascertained prior to demolition. If extensive structural damage is required, owner shall be
contacted prior to conducting repairs for review and additional fees may be required,
THANK YOU FOR THE OPPORTUNITY TO BID THIS PROJECT. PLEASE FEEL FREE TO CALL IF YOU
HAVE ANY QUESTION,
CONFIDENTIALITY NOTICE: All infonnation contained in this proposal is confidential and privileged. The
infonnatioo included in this docwnent is to be utilized by the individual or entity named above. The authorized
recipient is prohibited ftom disclosing this information to any other party. This informatioo shall be kept strictly
confidential prior to Award of Contract,
This proposal may be withdrawn ifnot accepted within 30 days. TOTAL $1,987.00
ACCEPTANCE OF PROPOSAL, Sign & Date
CONLON CONSTUCTION
October 6, 2004
CONLON CONSTRUCTION CO.
1100 ROCKDALE RD (52003-7875)
P.O. BOX 3400
DUBUQUE, IOWA 52004-3400
(563) 583-1724
FAX (563) 583-2162
E-Mail: conlon@mwci.net
www.conionconstruction.com
GENERAL CONSTRUCTION
CONSTRUCTION MANAGEMENT
DESIGN/BUILD
Mr, Leddy Bastian
DUBUQUE INTERNAL MEDICINE
1515 Delhi Street
Dubuque, Iowa 52001
RE:
Canopy Repair
Dear Leddy:
Per your request, we are submitting a cost estimate of $2,400,00 for the referenced project.
Work would include the following:
0 Removal of existing damaged metal clad fascia panel
0 Replacement fascia panel and excess material to Owner
0 Removal and replacement of all damaged steel framing channels
0 Removal and replacement of damaged gypsum board
0 Repair and reinstallation of existing light fixture
0 Taping and finishing of new gypsum board soffit
0 Painting of entire underside of canopy 18' x 24'
0 Set up and clean up
0 Maintain entrance access
Note: If a new light fixture is required, add $30000.
If you have any questions, please call.
Sincerely,
CONLON CONSTRUCTION CO
/s/ Richard G. Luchsinger
Richard G. Luchsinger
Project Manager
Associated General Contractors of America Master Builders of Iowa Construction Management Association of America