Claim Allied Waste property 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 5393
4. Date of Incident: 12-08-05
5. Time of Incident: 12:00 Noon
6. Location of Incident (Be specific): BFI Recycling Facility on 1755 Radford Rd.
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.)
Garry Clauer was driving out of the BFI Building and forgot to lower the tailgate
of the truck and damaged the overhead garage doors and frame.
8. What were weather conditions like? Cold
9. Give name and address of any witnesses None:
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.)
The door frame, door, sprinkler line above door, and wriing were damaged. In addition utilities were significantly
higher due to door open until repaired.
13. What other damages do you claim, if any?
$10,235.54
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?
$10,235.54
16. Why do you claim the City of Dubuque is responsible?
City Driver damaged property
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 22nd day of March, 2006..
/s/ Mary Jo Rooney
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
MAR.22-2Q.(){i WED 03: 09 PM IlUSURVllISlLC
. Ma r: 22~ 2006 2: 22PM CITY OF DBQ LEGAL DEPT
i563 556 0727
No, 7052
P,002/003
p, 25/26
CLAIM AGAINST THE CITY OF DU~UQUE,IOWA '
This written report Constitutes your claim, against the City of Dubuque, Iowa. Yo~ shoLild
complete this form In full and attach any add'tlonaflnformallon that supports your claim.
The Claim must be flied ~it1) the City Clerk at City Hall, 50 W.131h St., DUbuque,: 11\ ~2001.
It will then be referred by the City Council ,to thEl appropriate department for investigation.
Once that Investigation Is completed, Ii' report and recommendation will be submitted to the'
City Council. You will be provided with a copy of t~at re'po~,l(In~ recomm.,nd.~lon.
THE FINAL DECISION ON ALL CLAIMS IS MADE l:JYTHE 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 ae PAID. '
, " " . ,
1. Name Of' clalma~t:-1111, ec!' Wa. s-le...
2. Address: \...., 5 'S Rad{"lord Raa4
3. Tefepho!le Number: 5' b 3 - S'5" - 5.3'1 ~
4. Date of Incident: ' I ,;;l.' -0 g - CJ 5 ' ,
5. Time oflnciderit; '] :2 ~,O 0' na!1 n
6: I::~Btlon of incident (Be ~peCific): "12; FI Re:.c..if:.\ I'WJ Fc.(c. i '/ ~~'" o'n
II 55 Ro.d~d RJiA.d ' " ", "
, "
7. 'DESCRIBE ACCIDEtn: o~ OCCURRENCE'THAT CAUSED INJURY OR DAMAGE, (GlvQ
full de~lI~ ,upon',whlch youb~se 'your cl~lm, It~ City emp'9,ye,e WIl~.lnvol,ved;,give the
em)llpyee's nawe.)" _ ~ -..lJ.. 0, -, , ,fl., '(.J_ I, '
horrlf l1\aU.o r UJas dnv\nq Duh,n-,nUl Or:r.~UI (.Al~ ,([,~ '
~rqot -T-D )oWQr~dqai-L c*- ~ +rurJ? IlAyi da.maq.uJ
....::f:ho . {JV,QYY\pa..l 'qaroq.t ll()oY'"S ~-4-~
8. What were weather conditions like? (!o I d
9. Give name and address of any witnesses: ' AJonL
10. Old police investigate? (f so, give names of offlc!lrs.)
11. Was anyone Injured? (If ao, give names, addresses, and extent of Injuries).
/Vo
,
MAR-22-2006 WED 03: 09 PM If! !ASlE SERVIIISllC
. w . ..
Mar,22. 2006 2:23PM CITY OF DBQ LEGAL OEPT
i563 556 0727
No, 7052
P,003/oo3
p, 26/26
.'
12. Was any damage !fone to property? (11 SOj desaribe property an!t the extent of damages.
Attach esllmates of damages or describe basis for ascertainlngexlent of damage.)
, ---nu. rioo (' .-9-ra m.o. 1m rl r, ~P(' Ink \ QX hne.- ab.a..v f
dnn~ iv~ WIll da.w9Q),. ~aMrh.o'f"\ .
-,--u+il:t1~ ~~( 1 s~ ~ h~l~~ -to clOO r Op1t\ unil \
13. What other damages do you claim, Jr any? .,'
~. J 6 I d. 3 '5 , '5 4
, ' '
14. Have you been ,comperislited for any part ,or. ail of your claIm .by any insurance
company? (If so, give name B.nd address of Insurance company Bnd amount paid.)
no
15. What amount do you cllilm trom'the City of Dubuque? .
4 )0, d-3:=>. sy
, '.~ .. .
<::'.....
16~ ' Why do you claim thG City of Dubu~e Is responsible? . .
. ..' ."M'... .\ "'(' . "
".. " r!dij. riilVP~..uL prtJfllrhf,
Dated .t D!,Ibuque; Iowa this d(;).
day of Maren . 20.Q.k2...
nw~~
J.1a rfj ..J6. all f1Uj-
(Print Nam~
(Rev. 1/00 & 7/01)
MAR-/2-2006 .l'IEO 03:09 PM IfI!ASlE:l:RVlctSLLC
. .
i563 556 0727
p.001l003
DATE: 03/22/06
)'A \Z(
ALLIIiD W,Al1'1 SERVIC.I
FROM: Mary Jo Rooney
FAX COVER
SH55r
TO: Tracey Stecklein
COMPANY: City of Dubuque
FAX NUMBER: 563-583-1040
PHONE NUMBER: 563- 583-4113
PAGES (Including cover sheet): 3013
Tracey,
Thank you for faxing the information. I am returning the claim against the city for the first
accident. I need to locate the invoice from Althofer for the second accident and will
submit that claim tomorrow. Please advise If anything else is needed. Thanks for your
help.
Mary Jo Rooney
Division Controller
(563) 556-5393
NonCE Of CONfiDENTIALITY
The Information contained In and fransmUfed with fhls focslmlle Is confidential. It Is Intended only for the Indlvlduol
or enllty designated obove. You are hereby nolltled fhot ony dissemination. distribution, copying or use of or
reliance upon the inlormation confained in and Iransmllted with this facsimile by or fo anyone other than the
recipient designated above Is unauthorized and strictly prohibited. If you hove received this facsimile In error.
please notlly Allied Waste by phone at Oocal phone number) Immediately. Any facsimile elToneously Iransmitted
to you should be Immediately returned to the sender by U.S. Mall. or It the sender grants authorl%allon, destroyed.
If you have any trouble receiving this transmission, please call (local phone number).
1755 Redford Rd
Dubuque. IA 52002
Phone 1563) 556-5393 FAX 15631 556-0727
www.disposal.com