Claim by Dawn ShefferTHE CITY OF
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TRACEY STECKLEIN
PARALEGAL
MEMORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: December 10, 2013
RE: Claim Against the City of Dubuque by Dawn Sheffer
Claimant Date of Claim Date of Loss Nature of Claim
Dawn Sheffer 10/01/13 09/20/13 Vehicle Damage
This is a claim in which claimant alleges that while she was driving near 4343
Chavenelle Road some concrete broke loose on Chavenelle Road and damaged her
vehicle.
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
Dawn Sheffer
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
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. You should
complete thls 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: Dawn Sheffer
2. Address: 119 E Lafayette St., Cuba City WI 53807
3. Telephone Number: 563 - 552 -6234
4. Date of Incident: December 5, 2013
5. Time of Incident: 12:10 p.m.
6. Location of Incident (Be specific): In front of Rite -Hite loadinig dock area
4343 Chavenelle Rd., Dubuque IA 52002
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.)
Chavenelle road at said location had a large chunck of the cement road that broke free and when I
drove over the large chunk it damaged my axel, passenger rear tire and rear suspention and ability to steer.
8. What were weather conditions like? clear
Jodi Ungs
9. Give name and address of any witnesses: 12275 Circle Ridge 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? Of so, describe property and the extent of
damages. Attach estimates of damages or describe basis for ascertaining extent of
damage.)
no
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.)
insurance claim has been submitted, Geico, 1- 800 - 861 -8380
$1000 insurance deductible and any
15. What amount do you claim from the City of Dubuque? other expenses not covered by insurance.
16. Why do you claim the City of Dubuque is responsible? poorly maintained city road
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 5
day of December
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DUBUQUE
AUTO PLAZA ..ti,,
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600 Century Dr. & 1685 JFK Rd.
Dubuque, IA 52002
Bus: 563 -583 -7345
Toll Free: 800- 373 -CARS
Fax: 563-583-7349
Email: kevins@dubuqueautoplaza.com
Kevin Schwarzhoff
Fixed Operations
Director