Claim Allied Waste vehicle damageCLAIM 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: Allied Waste
2. Address: 1755 Radford Road
`
3. Telephone Number: 563 556 5902
4. Date of Incident: 2-17-06
5. Time of Incident: 11:30 A.M.
6. Location of Incident (Be specific): Allied Waste Recycling Center,inside building
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.)
Alvy backed into the area to unload his paper and backed into
the Allied end loader.
8. What were weather conditions like? Cold
9. Give name and address of any witnesses: Terry Dolan
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, Door & door frame were dented.
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?
$937.25
16. Why do you claim the City of Dubuque is responsible?
City Driver hit end loader
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 23rd day of March, 2006.
/s/ Mary Jo Rooney
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
MAR-2~2D06 WED 03: 23 PM Ill~~W:~Ia:SlLC
\la"r,22. 2006 2:22PM CITY OF DBQ LEGAL DEPT
1563 556 0727
No, 7052
P, 002
p, 25/26
. -
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA '
This written report eonstitutes your claim, against the City of Dubuque, Iowa. Vou shoJld
complete this form In full and attach any additional information that supports your claim.
The Claim must be flied ~It~ the City Clerk at City Hall, 50 W.13t11 St., Dubuque,: IA ~2001.
It will then be referred bV the City Council.to the appropriate department for investigation.
Once that Investigation Is completed, ~ report and recommendation will be submitted to the'
City Council. You will be provided with a copv of that report. ~nd recomme.nda.tlon.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY ,THE CITY COUNCIL. NO EMPLOYEE
OF THE CllY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESI:NTATlON TO
YOU AS TO WHETHeR YOUR CLAIM WILL OR WILL NOT BE P.AID. '
. '. . '
1. Name of' Claimant; , A \ \ \ -e.- J' UJa.S~
2. Address:_J155 Rad ~(J Rood
5/,3 -S5'~-DqOd,
,;;) ~ 11-01-,
6. Time of Inclde':"; I I " 3 () a VY\
6: ~~~d~n of incld~nt (Be, ~peCifiC): '" . PI \ \ \ i'l . U;ts-1e.; kti(ll{f~~"
j. L .. n 1, ;"4' " '
\ I'\MOJ..- t1W J..V""""'-l . . , :'" , '
7. 'DESCRIBE ACCIDENT OR OCCURRENCE'THAT CAUSED INJURY OR DA.MAGE. (G1VQ
full detaiJs ,upon. which you .b~s. 'your c~lm, I'... City emp~~ye,e W!ll~ . Involved; ,give the
~~:t~t(:t:~~~hih~~ ... ..
. '.
3. Telephone Number:
.'
4. Date of Incident:
8. What were weather conditions like? (!.j) Ie;{
9. Give name and address of any wltnesses:--=:J1 rr~--.ChJl/r'u
MAR-22'-2006 WED 03: 23 PM. IIH~HR'llctSllC
~.rr. 22. 2006 2: 23PM CITY OF DBQ LEGAL DEPT
i563 556 0 J27
No, 7052
P, 003
p, 26/26
12. W"s any damage lione to property? (I~ ,so; descrj~ property an~ the extent of damages.
Attach estimates of damages or describe basis for aReMalnlng 'extent of damage.) ,
l{J /.J.- . Do 0 , ~, Lio 0 y- fffiII'\iVI. U) 1 r Q.,~ '. ..
13. What other damages do you claim, If any?
n~
14. Have you been ,compensated for any part :or ,ail of your clilim ,by any Insur..nce
company? (If so, give name and address of Insurance company and amount paid.)
, f);() ,
15. What amount do you claim fi'Om'the City of Dubuque? '
, ~ q 37. ;;1.5
...., .
,-
16. Why do you claim the C,tty, of Dubu~e is responsib!e? '
", "c.1'tlt' Dn \JJ. '(' h ~+ fLM I()~:!''''''
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.,;.....
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17.' 'H.v~'~clli,n:iad."any claim 8gai~8t anyone eJ.'e 'for' d.mils'e. 'e88 result of'thlslh'cident? .
(If yes, givelllimeand'addrass.) ',M.. " ,'.', ""'"
1ft, If'the im~wer to Question 1718 yes, h~e you receIVed any payment from that source,
and If IlQ. in' what amount~
. ,
, ,
, '
Dated et .~Ubuque; Iowa this .0..3
day of Ma r c.h
. 20..Q.b.
,
'-
~Q~
' , (Signature)
'~ JO eo~
(Pri~t Name)
(Rev. "00& 7(01)
MAR-22-2006 WED 03: 23 PM IIU~URY[[fSliC
'MAR-22-2006 15'46 I'ILTDRFER INC
i563 556 0727
p, 004
P.01/02
SOLO TO
BFI-ALLIED WASTE
DIV 897
1755 RADFORD RD
DUBUQUE IA 52002-2532
((ALTORFERJ) ALTORFER INC.
ConSlI'uctlon: Power Systems: Ag Machinery: Lite Truck: Compoct Construction; paCkaging,: Rentsl sarvi01-od
~~ 1~
f1\fI~,
SHIP TO
1~"CN:JXl!~t:\'l:~~~~T4MMImDY.~~eu~'raJllftR'i~lfilii~~""fII'I.iI'J'IllI~.QII~IJt<"_~A~;;:1~;I'w."-ln...~:c;..lIIN!.~.J::t''ti'lIll'-M>>I:1eitl'''''lt:''r!tlj~rlij.~.'~
W02 0168710 O~~16-06 663649 10 G 415 1 1
fl~'!'l-:tr.MiI01Wf.I'W"~~~!i1!I!Il'r.lI~.ilIl!I~..i~'!.I!k4...l'~1\!$7~:t'm~;'.fi~~U~l'jl"i!'!t'2:!=-.,!JS~~~~Imi01T&\:'Jti:i!J!tS!C~~jti~'!li!!u.~~::~:!\"!'l~~~.:::.,,,.;...~)'i~~t1U\1;:AIft~I'iIlBIi'liAi:;;~"~'1
CR2B404 02-20-06 10 10 10 3431364
1'::'::'~~:'Jiii~~.:!t;Ji'ii~~j!:i!MO'8B.'l~:=~~:W;.!~~~-:~~~td.-_...ft1M~~~~:!i::~~~,*IUlMHU''''IIW&II~~~~:~,;!j);M;rmw;READIWJI;:;oioiUiiwli'''d~~..,(aHrl.'lD~tJIIO~.~..i.da!J
M'
950G II
*CAT0950GCaYL00546*
......,.
~!!~~ :~~p'..' .:~~~~~
~.M ""II'
.iji,'l'l . """;~, -""':W
2262,0
054U37
. 'r:t.!':O~...""""""';.l,.: "~!~.., .....
-
",n'"
, "~"'~::",:,:,.:;~.::--...
REPAIR MACHnm
CUS'l'OMli:R COMPLAINT:
ct;rSTOMRR. REPAIR
REPAlR COMMENTS:
LOOKED UP THE: SIOI: PANEL ON THE LErl' SlDB OF THE
CAB. FOUND IT WAS GLUED ON. ORDERE!:) THE PLATE
AND THE GLtl'B. USED KNIFE AND COT '!'HE GLUE TO
REMOVIi THE C!OVER FROM THE CAB. PR.IED THE COVER
OUT 'ro CUT THE INSIDE GLUE. GOT THE: COVER OFF OF
THEil CAB. SCRAPED THE GL01l OFF OF THE CAB. trSm
80MB ADHESIVE RBMOVER A1l1O CLEANED OFF ALL 'nD!l
GLUE. HAD BILL X REPAIR. PART OF THE CAB CHANNEL
THAT GOT DAMAGED. CLEANED UP THE. NJllW COVBR. PUT
GLUE ON THE COVER AND THE CAB. LiT IT SIT A FEW
MINO'l'ES TO TACK UP. PIlT ON COVER AND POSITIONED
WHERE I I>/'J\NTED IT. TAPED I'I' ON so IT WOULD OOT
MOVE. CLEANED UP EXC&lSS GLUE.
3 119-0781 ADHESIVE lIT
45010
1 149-1163 PLATE AS-IrH N
45010
1 176-2468 HANDLE AS - PA ,N
45010
28 DIESEL FUEL DIESEL FUEL S
14100
'1'OTAL PARTS SEG. 01
16.43
49.29
127.5'
127.59
125.44
125.44
3.25
91. 00
393.32 *
lnqulll.. lfhouJd be d1rel!:toli tOI AIIDJte, Ino.
P.O. 80. 'M7
Cedu fluid.. lA 52406--134'
PlII'H8!>OIIG1 ... 319-385-61139
DI~I~~T ""
1m-HMOX.
PAYTHlS ...
AMOUNT ....
AMOUNT
CRI!DITED ~
. AU. F1E'l\1RNAElLl f',ARTS ARI -.cCEI'"TABLI
FOA CRf.DIT ONl.Y BY OUl', "UTHoRIZATtCI'll.
Tf.q;y MUST IE AFnJA.NED WITWIN '1 gAYS
AFTER OAY OF SHIPM&ttl' TO AVOrc
HANDLING AHD R!STOCIC.INQ CHMIJEB.
lEI .. NO CFlfDIT ALlOWED ON PArlTS "ITU~N!D
. . llNLiSS IIIIVDlc~ NUMBER 18 f1UftNI5/'fW.
. M NOT I!!TUftNAlL! 1TEM5 NOT SHOWt.I
Aftf f1ACKORDERI!D
MAR-22-2006 WED 03: 23 P.M
If!WASlE~I[fSllC
i563 556 0727
p. 005
P.Iiil:2/02
t1RR-22-201iil6 15'47
AL TDRFER I NC
(rALTORFERJ)
ALTORFER INC.
Constructi"" : Pewer Systems: Ag Machinery: Uft Truck; Compaal Construction: Packaging; Rental Servioes
SOLD TO
BFI -ALLIIID WASTE
DIV 897
1755 RADFORD RD
DUBUQUE ~ 52002-2532
SHIP TO
~K~'-'-flnl~wwrr~1;rr~ i';~~.~ ~~~~~q:tc:r.nJr~~Z3t~j)~~,t't,to!\T""Ir-PE't~;~WJ.~~.:t~~t~:l~~~-i.:2t:1]Jj~~:;',~"''Wf,=T~~
W02 0168710 03-16-06 663649 10 (J 415 1 :2
L~::~::mmwa~.~,.zo.!;.!H~~m~t~dJJ'j;Wlllilm'..t!Jl!~~I:m~r.m::~~1l/l~~IiI1~~ifIft.~~~~~~~~=~;rn'~~'!I.'!:"1l!S!Il!4Mm!ldJ_:sea:~"blll"..;;"#..~
CR28404 02 20 06 10 10 10 3431364
1:::.,.-:~~....1iitii.!~'iI..::ji't~:jCi#AA;~~~~~~li"ll1Wt.ir<;~4'~:iiIl:Ir:Y.1~"""'-'MNilliJu:i>'mr,:~~<w~1.'J'" liMlJlDDfldiil4~4~~r;'~~~'M;;;CH~1IDiiitUlIrh"_"~"'\!~
AA .950G II *CAT01l50GCAYL00546* . 2262.0 054U37
t.!;''?'fi;DIIArrnlMiil1m~=~t::!:.1.':iC:::ft'dII~~~o@iJ.ijl~li~~~I~~;,::';:::~t~l~~1".a~E.OJ~~~~.l!~~~~ij'Iif~~j~~~~~E:...~::.''':'':'~i~~~~4
TOTAL LABOR
SEG. 01
380.00 ...
1.00
1.00
REF DOOR U1l.M
TRANSl'OR'l'A'I'J:ON
TO'l'AL MISe CHGS
SEGMENT 01 TO'l'AL
46500
15555
90.00
13.50
BOO. 01
103.50 ...
876.82 T
--------------------------------------------------------------------------------
IOWA SALBS TAX
1 % CITY TAX
lllr SCHOOL TAX
43.17 T
8.63 T
8.63 T
************~******~***************.~**~****************************..
PLEASE DIRECT WORX ORDER INQUIRIES TO
THE SJilRVICE MANAGER: FH 3lSl-365-0551
... ... ...
* ... ...
CASH
INVOICE COPY
... ... ...
* ... ...
tnqu..... ahGUtd be cir8cted to: Allorfw Ino.
P.O. 80.. 1147
CIId... fWd., IA. 1.2406-'347
Ph 31e.s1l6-<lSel Fa. 319-366-6639
CA$H
uB~~~t. ~
PAY THIS ....
AMOUNT ..-
AMOUNT ....
CREDITED ..-
.. . '''O'r 1I1'fU,UueL.l
ITEMS NOT SHOWN
ARE BACICOnDIAlD
~1ii:~~fl
~ ~. . ... .. - ,
ALTOFlFEI'lINC.
P.O. BOX '347
CEDAA RAPIDS. lA 12408.' 347
. .i.U. PI!TURNAEI\..t PAJilTS ARI!. ACCEPTABLe. 1m
,.O~ CA~IT ONI.Y iV OU~ AUTHOAltA'nON,
TH~Y MUST ur:. "f'T\fflNig WItHIN 11 PAYIJ I
A~ DAY OF StlF'M!NT TC AVOID
HANDLING AND Il!'SToaIQNO Ctf,,"BE5,
. NO CAfOIT AU.OW!O ON,.ARTS AETU"NeD
UJrrn.E8S INVOICl NlJr-tlEA 16 FURNISHED.
101Ft.. P.1iil2
Ilfl !ISlE :BIIICiS lL~
i563 556 0727
p. 001
. .
DATE: 03/22/06
)~ill(
ALLIID w",. ,.AVIC.S
FROM: Mary Jo Rooney
I'AX COVEll
SHEEr
TO: Tracey Stecklein
COMPANY: City of Dubuque
FAX NUMBER: 563-583-1040
PHONE NUMBER: 563. 583-4113
PAGES !including cover sheet): 5 of 5
Tracey,
Thank you for faxing the information. I am returning the second claim against the city
for the endloader accident. Please advise If anything else Is needed. Thanks for your
help.
Mary Jo Rooney
Division Controller
(563) 556-5393
NOTICE Of CONfiDENTIALITY
The Inlormatton contained in and transmitted with this facsimile is confidential. It is intended only for fhe Individual
or entlly designated above. You are hereby notified that any dissemination, distribution, copying or use 01 or
reliance upon the Information contained In and transmitted with this facsimile by or to anyone other than the
reciplenl designated above Is unauthorized and strictly prohibited. II you have received this facsimile In error,
please notlly AlUed Waste by phone at (local phone number) Immediately. Any facsimile erroneously transmll1ed
to you should be immediately returned to the sender by U.S. Mall, or If the sender grants authorization, destroyed.
If you have any trouble receiving this transmission, please call (local phone number).
1755 Radford Rd
Dubuque.IA 52002
Phone 15631 556-5393 FAX 15631 SS6-<l727
www.disposal.com