Claim Jones, Connie
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:
2. Address:
`
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
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.)
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.)
13. What other damages do you claim, if any?
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. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
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 , 20 .
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
This written report constitutes your claim against the City of Dubuque, Iowa. ~y
complete this form in full and attach any additional information that supports your claim.
. .
. .
cc.'
CLAIM AGAINST THE CITY OF DUBUQUE,"'IOWA
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 inve$tigation.
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.
It ,~
1. Name of Claimant: '___.>'0(\(\, e __ ~ oneS
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2. Address:
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6. Location of Incident (Be specific): ~ (""()~
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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
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8. What were weather conditions like? W i f'lc\
9. Give name and address of any witnesses: ~ U .c70n \A.)D-~.7 ~€-re --
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10. Did police investigate? (If so, give names of officers.) lUCY { lA '7fr, :f-o,,0QfF-
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? JJ f) VI (J
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.)
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15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible? I Dfitee
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) Dc)
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 , 20~
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(Print Name)
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(Rev. 1/00 & 7/01)
--, .
,---,--'.
Connie Jones
1790 Key Way
Dubuque, Iowa 52002
563-588-8634 before 3 pm
July 8, 2005
To: City of Dubuque,
On June 4th at midnight I was watching T.V when the storm came and blew a tree
down on my home, right where I was sitting. I feel that this tree wouldn't have
come down if the roots on the tree were not cut off prier to the storm. I was told
by one of the workers this tree was up for more then 32 years. And we get a lot of
wind in the area. And it hadn't bother the tree before. They worked on this street
from October to just this spring. They had dug out the street and the curb twice.
Sincerely,
C~
... '---,
Signature
Dan Davis
563-582-9155
~roposaI
DAVIS
ng & Siding
1700 1 Rooster Lane
Dubuque, Iowa 5200 1
CI .
DATE
"/-/~-o/
PHONE
We hereby submit specifications and estimates for:
To tear off old roof, clean up and haul away. Use magnet on area for loose naili. Install #15 felt
paper, ice shield, new metal edging, new boots on stacks, new vents. Then install Landmark
asphalt shingles with 40 year warranty. Total includes material, labor, tax, permit and dump fees.
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Plywood needed: 0 Yes ~ Z- 7 () d '
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We Are Insured and Bonded.
We ~ropose hereby to furnish material and labor-<:omplete in accordance with above specifications, for the sum of:
dollars ($
Payment to be made as follows:
All material is gueranteed to be as specified. All work to be completed In e workmanlike
manner according to standard practices. Any allefatlon or deviation from above
specifications involving extra costs will be executed only upon written orders or verbal. end
will become an extra charge over and above tha estimate. AU agl'99ll\9llls contingent upon
strikes, accidents or delays beyond our control. Owner to carry fire, tornado. and other
necessary insurance. au.. wol1<ers 8I'e fully covered by Workmen's Compensation lnaurance.
Authorized j~ 1- ~ .
Signature ~ - ~
Note: This proposal may be
withdrawn by us if not accepted within
f
u
days.
~cceptance of t)topo~al- The above prices. specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined ve. ."-----
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Date of Acceptance:
Signature
ELW Corporation, dba Weber Concrete
1450 Tower Drive, Apt. 2
Dubuque, IA 52003
Phone # 563-556-7540
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Proie",\
CONNIE JONES
1790 KEY WAY DR.
DUBUQUE IOWA 52002
Invoice: 007842
Date: 7-5-05
Description:
REMQVB.ANa;auL.W&<u.&Q!';~"WALKS
w""'en {-Ye..-t \0~6 p.JleJ ~'
Balance Due:
.
$~O.OO