Claim Sisters of the Presentation
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. CLAIM AGAINST THE CITY OF DUBUQUE;' IOWA M~
This written report constitutes your claim against the City of Dubuque, 10w;Myou 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: Sisters of the Presentation
2. Address: 2360 Carter Road, Dubuque IA 52001
3. Telephone Number: 563 588 2008
4. Date of Incident: 9 13 05
5. Time of Incident: 3:00 P.M.
6. Location of Incident (Be specific): . West Drive of Moterhouse where canopy is located.
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.)
Mini bus Driver drove under canopy to drop off passenger. Canopy is located on West End of Mother house. When Driver was exiting under canopy Roof kHatch
caught the north edge and tore offand damaged boards.
8. What were weather conditions like? Warm and sunny.
9. Give name and address of any witnesses: Sister Karen Jasper, 2360 Carter Rd., Dubuque IA 52001
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.)
Yes, Canopy boards were torn off and destroyed causing need for replacement.
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?
$401.00
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16. Why do you claim the City of Dubuque is responsible?
Bus Driver didn't use proper judgement of clearance going under canopy roof.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If ye!}, 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 2nd day of December, 2005.
/s/ Sr. Ruth Ann Takes, PBVM
John R. Schwendlnger ConstrucUon
800 Kelly Lane
Du~uque. Iowa, S~P03 . , .
Phone 563.556-0645
INVOICE
Sisters of the Presentation
NAME
2360 Carter Road
DubuqueJowa, 5200 I
Address
Date 11-21-2005
Description
Amount due for labor and materials provided to tear off broken facade piece on front entry roof and to get and
instaJllhc new piece.
Fypon _________________________________________$213.00
P.L-Premium and caulking--------------$ 28. 00
Carpenter labor and getting of
material. .Constmction service ______________$160.00
$401.00
Tenns Net 10 days
Finance charge of 1 1/2% per month, 18% per year on accounts past due
Please pay from invoice Amount due=$401.00