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Claim by Linda Loney• ~~~ //°j~ (~ ~f'~i ~ Page 1 of 2 G ~~%~~' ~y ~ y~ CLAIM 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 West 13~' 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 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: Linda M. Loney 2. Address: 2285 Graham Circle 3. Telephone Number. 563/583-4099 4. Date of Incident: Tuesday, April 24, 2007 5. Time of Incident: During Garbage Pick Up (about 10 a.m.) 6. Location of Incident (i3e specific): On the curb outside of my home next to driveway, 2285 Graham Circle 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 employee's name.) I don't have a specific name of the person who does my garbage pickup but my garbage can was broke on Tuesday, April 24th during regular pickup. The wheels were broke off the can and no longer stands up on its own. 8. What were weather conditions like? Cloudy and rainy, off and on 9. Give name and address of any witnesses: None that I know of 10. Did police investigate? (If so, give names of officers.) No the police did not investigate 11. Was anyone injured? (If so, give names, addresses, and extent of injuries.) Nobody was injured 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.) My garbage can has wheels and a handle to pull the can. The wheels were broke off the can and now the garbage can does not stand up on its own. We tried to get the wheel back on by "rigging it" but there is noway to keep the wheels from coming off. We have to prop it up against the wall to keep it from falling down. 13. What other damages do you claim, if any? Just that my garbage can now has no wheels and fallls down. 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 compensation of any kind has been made 15. What amount do you claim from the City of Dubuque? To replace my garbage can with a similar can with 4/24/2007 Page 2 of 2 wheels. 16. Why do you Gaim the City of Dubuque is responsible? When we put the garbage out that morning the can was how it had been. When I came home from work on Tuesday, May 24th the wheels were completely broke off of the can. One wheel was laying next to the curb about three feet from the can. 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 this 24th day of April, 2007. C7 -' (Signature) w~ ~ rt -" ~-tl ~~ ~ncSc~. YY1 _ ~U ~.L -~' ~ 3 (Print Name) ~ y ^' W ~ cs't n O '.~ ,~ ~ 7J ~l t ~~ C m tV Sa ,~~.. ~ ~ Z ~~ N {7 (~ ..- ~ 4/24/2007