Claim by WielandBARRY A. LINDAHL
CITY ATTORNEY
MEMO
To:
DATE:
RE:
Claimant
Mayor Roy D. Buol and
Members of the City Council
December 22, 2006
Claim against the City of Dubuque by Keith Wieland
Date of Claim
Keith Wieland
12/20/06
Date of Loss
12/20/06
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Nature of Claim
Property Damage
This is a claim in which the claimant alleges that while City of Dubuque Park employees
were removing a dead tree from in front of 2910 Jackson Street, a tree limb broke off at
the base and snapped off claimant's flagpole.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
BAL:tIs
cc: Michael C. Van Milligen, City Manager
Jeanne Schneider, City Clerk
Gil Spence, Leisure Services Manager
Keith Wieland
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.org
Claim Form
,:
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
Page 1 of 2
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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 West 13v' St., Dubuque, IA 52001. It will then be
referred to the appropriate department for investigation and to the City Attorney's Office. 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 clams is made by the Clty Council. No employee of the City of Dubuque has the
authority to make any repre{seStation to you as to whether your claim will or will not be paid.
1. Name of Claimant: ~!L 1/j~- /C (a//~1f/iV /J
2. Address: o~~/U VAC~,~.U .S~
3. Telephone Number: ,~~~ ~~ Co
4. Date of Incident ~ (7 /~F C ~Ol~,r
5. Time of Incident: ~~ ~C~t9-/N
6. Location of Incident (Be specific): ~ ~~U ~~,4CC fU/~I .~ -
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7. Describe the 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 employeet7s name.)
9. Giv~ name and address of any witnesses: ~/ ~i= /~U /./ 1.1f
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.)
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13. What other damages do you claim, if any? ///(yt'./f /~/ ~/,$' T//j'f f
http://www.cityofdubuque.org/printer_friendly.cfm?PageID=155 12/20/2006
8. What were weather conditions like? / ~ / 2 , CLC7UD~~
Claim Form
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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.)
15. What amount do you claim from the City of Dubuque ~~/7. ~ U'
16. Why do you claim the City of Dubuque is responsible? C/T~ s//%Pl Uzi ~ 5
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Page 2 of 2
17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name
and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what
amount?
Dated this a~~ day of ~~~fEO/ -~ , 20 ~.
-111
(Signature)
(Print Name)
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