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Claim Bauerly, Jim (Bonjour EstCLAIM 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: Jim Bauerly (Bonjour Estates, LC) 2.Address: 2600 Dodge St. PMB III c/o Mailboxes & Parcel Depot 3. Telephone Number: 563 557 7112 4. Date of Incident: May 29, 2004 5. Time of Incident: Approx. 2 p.m. 6. Location of Incident (Be specific): 3355 Sunset Park Circle - Apt. 3 upstairs left side of the duplex ( (front apt. & door) 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.) Dubuque Police Dept. officer was ona call out to check an alleged sound of a gunshot at or near 3355 Sunset Park Circle. No one was answering, so they broke the door of #3 to gain access. 8. What were weather conditions like? Sunny & warm 9. Give name and address of any witnesses: Kim Schreiner 10. Did police investigate? (If so, give names of officers.) Yes - unknown 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.) Yes, the apartment door was destroyed. Also, the lockset and deadbolt. 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? $222.00 16. Why do you claim the City of Dubuque is responsible? There was no problem with our building or our tenants. No sound of gunshot was substantiated. 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 20 day of November, 2004. /s/ James Bauerly Bonjour Estates LC (Signature) (Print Name) (Rev. 1/00 & 7/01) ",~'/ 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: JiM ßCH'_~Y (ßoV),'J'...r õ'fz:tT:!õ .L,C) 2. Address: 2 lDoo ¡)"J r<- (; t P 11 ß /I / e¡. ""cu I,>" ,¡et'{ +- P"-<'G.t. Ì)p('o-t 3. Telephone Number: 54> 3 - s í ? - / II L 4. Date of Incident: (YI c"J ;L ell J-.::> 0 '-I 5. Time of Incident: AfPo'V>" :J- P,.., 6. Location of Incident (Be specific): "11' r hi r 1: / 'f' f -¡- S:'.{ L )3Ç" j", '" F-C-T /,c,v-k C,' p-< (~ .,yr- ? IF tL-.... 'i -¡lex: ((:.v.vt A,. T ':>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.) :)«'>"["'- f'"I.'c.e.. ù.t/r ",fF-,-<-e.v- 1,/«5 0'" '" c",ff ...r 1-» ,or .......... cL.,c. '°, "f(~f.L"( f'::>IA"'!..ç '" 'J~'" fCO'¡- G> T '3"} \Vj- r;:.~ f-< f- f1..v~ Cv-r'r": ¡J~ oN'-<- <A-CdC¡"f~r'V<J .r~ Th. , ~V1) k~ ~é ~'" fF, fL..", ,( vv V' ( £1'3 1'1> v'7~"'; 8. What were weather conditions like? SL.""'"" - ¡...-c;...."'--- - 9. Give name and address of any witnesses: k""" S c (.,r<" '.--..e ..--- ;, 3 .;-~- $41'1 {rl" t't,d c¡~ ~rl 10. Did police investigate? (If so, give names of officers.) rr. '-<",{,-..,,~-../' 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). fY'V 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.) , c;.R.J, íL. 'r<;~+....-..<.~f- ¿uo".- (oc.t,F-VI """'< d.-ad ~¡)/T: t-4 J d", J ~ )-"-Ø. . ,4--( .1'-0 ree 13. What other damages do you claim, if any? /I/'!' AI ~ 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.) /'J ;) , 15. What amount do you claim from the City of Dubuque? sr :J;2;J..,dO 16. Why do you claim the City of Dubuque is responsible? ~ h<. ~. c.lrCt S' ,0/'0 /1Vl/ ~ (.. ""'-- , vv ,tr., «/.... ~ b <.A., 1J. "') OV 0'-<" +-c"c;.."rI. ¡V" S '" <. vc ,( -( ~,,~ j'1... t / C-V"'/ >t..{;, )/7;" f,,~.,.d. 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) ,v1? 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 ')0 day of /1J D v--'! ~ >e,/' ,200'1. ," 1~ /)~/ ¡;,> !JVh/"A,/'<7ìkh {/ (Signature) loG; Jc¡~\ ;?CtH~~ (JD>1,'J<urbslzk-J (Print Na ) Le. (Rev. 1/00 & 7/01) BONJOUR ESTATES, L.C. 2600 Dodge Street PMB 111 Dubuque, IA 52003 June 13, 2004 City Clerk's Office 50 West 13th Street Dubuque, IA 52001 RE: Welfare Safety Check at 3355 Sunset Park Circle, Apt. 3 on 5-29-2004 On May 29, 2004 the City of Dubuque Police Department was called out to check on an alleged sound of a gunshot from one of the units at the four-plex located at 3355 Sunset Park Circle. Police officers broke open and damaged the door at aparbnent 3 of this building, No one was home, and the sound was not substantiated. With this letter we are hereby making claim for restitution of property damages to the building, specifically the door destruction that resulted from this intrusion. The total damage amounted to $222,00, This includes a new door, lockset and miscellaneous materials, Thanks, Please send the check to the address above to Bonjour Estates, L.C Sincerely, James w. Bauerly Manager. Member Bonjour Estates, L.C . . . . . . . . . . . . . . . . . . . . . . . . . . . . ----- -------.-- THOMAS THILL CONSTRUCTION 757 Rush Street DUBUQUE, IOWA 52003 (563) 588-0453 CUSTOMER'S ORDER NO PHONE NAME' .f) , \ '~ VY\ ~ v-tl" Y ADDRf3¡ J {òr 'b3SS- 5l1fts~r SOW BY CASH MDSE. RETO. PAID OUT OTY. 3C, )( 8Q I ~ (" u Ct- ~ Oøx- Sw\\'\ -+ VGLrl\ìSh Pov-r L O,-/c::.s,ç.+- ...... lf4,ß'-cl 6Ð f t- La Gzrr 6ftr PAl CK. (J:J--'?2- DAi RECEIVED BY PRICE TAX TOTAL -:J:k-3 AMOUNT 9iDt> I ID¡aV , t,~ , , lðv:ðO . , , , , , , , , , , ~:òt) All claims and returned goods MUST be accompanied by this bill. 1135 ~ ToReordec 800-225-8380 or nebs,com L '1hank'-You