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Claim by LeRoy CainBARRY A. LINDAHL, CITY ATTORNEY MEMO To: DATE: RE: Claimant LeRoy Cain Mayor Roy D. Buol and Members of the City Council February 28, 2007 Claim against the City of Dubuque by LeRoy Cain Date of Claim Date of Loss Nature of Claim 02/20/07 02/18/07 Vehicle Damage This is a claim in which the claimant alleges that as he was merging onto Hwy. 20 from Bluff Street, the tire of his vehicle was damaged due to a pothole located on the merge ramp. According to the report of Street & Sewer Maintenance Supervisor John Klostermann, the Public Works Department first received notice of this defect from the City Clerk's Office on Monday, February 19, 2007. It is therefore the recommendation of John Klostermann to deny this claim for lack of prior knowledge. The Legal Department concurs with this recommendation. BAL:tIs cc: Michael C. Van Milligen, City Manager Jeanne Schneider, City Clerk John Klostermann, Street & Sewer Maintenance Supervisor LeRoy Cain 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 balesq@cityofdubuque.org CLAIM AGAINST THE CITY OF DUBUQUE, IOWA This written report constitutes your claim against the City of Dubuque, Iowa. You shou d 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. 13'h 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 DUBUGIUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU AS TO WHETHER YOUR C AIM WILL OR WILL NOT BE PAID. C ~- 1. Name of Claimant: LeRoy Cain 2. Address:3597 Crescent Ct. Dubuque 3. Telephone Number: 583-5911 4. Date of Incident: 2-18-2007 5. Time of Incident: Sunday afternoon about 2:00 p.m. 6. Location of Incident (Be specific): with in the of the approach to Highway 20 going from Bluff St. on to highway 20. 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.)No snow, streets were dry S. What were weather conditions like? Fair 9. Give name and address of any witnesse my wife was with me 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.) 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.) ~` ',-~/~ 15. What amount do you claim from the City of Dubuque? ~ rC~ ~ O~ 16. Why do you claim the City of Dubuque is responsible? /r'~ ~~ ~ 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) ,,~ _ , 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 ~ day of 20~. ~- ~, (Signature) G ` (P 'nt Name (Rev. 1 /00 & 7/01) Customer Invoice EXPERT TIRE Service Advisor:. 149460 DUBUQUE 01 DALE 02/18/2007 555 JFK RD 563.557.7321. DUBUQUE, IA, 52001 CAIN, LEROY 1994 MERCURY GRAND MARQUIS GS 1 Lic #: 531 NBA IA Vin #: DUBUQUE, IA 52001 In: 02/18/07 3:53PM Mileage:. 208,852 563.583.5911 Out: 02/18/07 4:08PM Store # 649120 RETAIL SALE Article Unit Extended Job Description Number ID Qty _ - Price- _ - Price _ -Total FIRESTONETIRE PACKAGE 01 61.89 098116 FR380 WS P215l70R15 97S 55,000 Mil e Limited 098116 05TN 1 65.99 65.99 Warranty DOT# HYHF38A3706 PARTS DISCOUNT FR380 WS P215/70R15 97S 55,000 7011430 05TN -1 6.60. -6.60 MILE LIMITED WARRANTY TIRE DISPOSAL FEE (1) 7075078 05NN 1 2.50 2.50 TIRE INSTALLATION 7015016 05TS 1 W/C N/C INSPECTION CUSTOMER REQUESTED_NO INSPECTION Technician(s): ., 05 JUSTIN VVEILANO Payment History: 3ummar1r: ECA Check 9679 66.05 2767 ' parts 59.39 Total Tendered 66.05 Labor 2.50 Shop 3uppiies 0.00 Sub-Total ; 61.89 Tax {7.00%) 4.16 . Total $66.05 I have received the above goods and/or services. If this is a credit card purchase, I agree to pay and comply with my cardholder agreement with the issuer. Customer Signature Initial here to indicate you have received the _ Tire Maintenance Warranty Book. Aq parts are new unless otherwise specified. TELL U$ AB'~Ul` YQUR EXPERIENCE AND (RECEIVE S1`b O~~ 1i(bUF't (NEXT RU.RGWASE 4+F;213 4i'Z MORE1 1) For a short surveys Cafl 1r8~0-931-1618 ar I©gon to http://www.experftire.cor'n/Experi0nc~; enter cods 649'120-14948q; 2) Write redemption code here: ~_ .Coupon expires 6 months from date of invoice; goon! at ail part'rcipa#ng t+bcations. Must have vsiid redemption code. May not be combined with any other offer or to reduce existing debt. No copies accepted. COMMITTED TO PROVIDING A POSITIVE CUSTOMER E RIENCE Pa e ~ of ~ See ~ reverse side for Warranty Information g EXPERT TIRE STD LASER -48-11-619-1 REV. 10/06 Invt 061102