Claim by Americana ConcessionsTHE CITY OF
Masterpiece on the Mississippi
TRACEY STECKLEIN ov�
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
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August 23, 2012
Claim Against the City of Dubuque by Americana Concessions
Americana Concessions 08/23/12
Date of Loss Nature of Claim
06/10/12 Property Damage
This is a claim in which claimant alleges that the electrical cord plugged into claimant's
concession trailer was run over by a City sweeper when Public Works employees were
sweeping the Port of Dubuque area during America's Riverfest, causing damage to the
cord and trailer.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
John Klostermann, Street & Sewer Maintenance Supervisor
Americana Concessions
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001 -6944
TELEPHONE (563) 583 -4113 / FAx (563) 583 -1040 / EMAIL tsteckle @cityofdubuque.org
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.
FiVIS • M M
1.
Name of Claimant:
2.
Address:
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3.
Telephone Number:
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4.
Date of Incident:
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5.
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Time of Incideft.
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Givo
full details upon which you base your claim. If a City employee was involved, give th
employee's name.) i
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8. What were weather conditions like?
9. Give name and address of any witnesses:
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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
damages. Attach estimates of damages or describe basis for ascertaining extent
damage.)
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13. What other damages do you claim, if any? Zi _Mj
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.)
17. Have you made any claim against anyone else for damages as a result of this incident.
(if yes, give - and .•.-
18. If the answer to Question 17 is yes, have you received any payment from that source,
2nd if i in what a° •
Dated at Dubuque, • •.. •` 2 1
(Rev. 7/12)
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