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Claim by Dubuque Bible Church BARRY A. LINDAHL CITY ATTORNEY MEMO To: Mayor Roy D. Buol and Members of the City Council DATE: May 15, 2007 RE: Claim against the City of Dubuque by Dubuque Bible Church Claimant Date of Claim Date of Loss Nature of Claim Dubuque Bible Church 05/09/07 03/14/07 Property Damage This is a claim in which the claimant alleges that that the parking lot black top located at 3500 Pennsylvania Avenue was damaged after a City of Dubuque refuse truck drove over it. 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 Don Vogt, Public Works Director Dubuque Bible Church 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 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 13th 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: .Ju ~3~t,9 a ~~ ~~ ~3c ~~- C ~~~.~ ~.~~ 2. Address ~S v C~ rel. %-t .- 3. Telephone Number S 4. Date of Incident: 5. Time of Incident: 6. Location of Incident (Be specific): 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 ~l~~"c~i~ j/t?wci( I=-,ri=ns:~ iJ~~ t,~i/~"T Lo? /=.-~I.2.a.~~.r. /=.E't ,.-, I~ L' -' +...4 -' /4 --~ ~] ~r/1 ~ /) ~~ /Q /3i L _~'°AS:_~rJG ~ /~ C% ~+ E, r/ T ~/%= G G ~ . T•~/i'.~ I~~i~' ~ Ci~f% jN/' ~AIT Li ~ %~-~irE'•4--sc;L A.-.J 8. What were weather conditions like? 9. Give name and address of any witnesses: i=in ~~ ; ~A ~ vl ~> ~ 5 J~ lr C.. ~! i ~75 ~ c G •4,e 0 • ~ t=/,'~ ~- A .7 r ~, JJ ~-* -? '~ t v~-- c..~,~..,,.v /iu ~ '3 ~Y~, ~cC 7 ~ o ~ ©`~ y3,. c~~ !T1 ~. `a '~ l ~Q o ~ m D n :- 0 ~: ~c, -~ //: ~ r 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.) _ 7f~~ fi~GA +~ ~ 7Ti2 it ~ ~<- l F t i '% h'c ~ c~ /~ T~~iL C i`/~ ~2 ~7~! ~-~ F~.2 K ~ ~ ~. L ~ T b' c. 4 t K 'TG f' 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.) /2.'0 15. What amount do you claim from the City of Dubuque? ~'~,; `/~ C: ~- f'ia..,ti., l'rF.a,.2 c:= c~ ; zE3f-i4,_75 3rs~s, zL 16. Why do you claim the City of Dubuque is responsible? ic't~ j~/akL SGi~~-1L77 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 this 7 .day of ~'yl~~r , 20 0 7. ( natur (Print Name) SELCO, Inc 15 South Main Street Dubuque, IA 52003 563/556-2434 BILL TO Dubuque Bible Church 3500 Pennsylvania Dubuque, IA 52002 Invoice DATE INVOICE # 4/6/2007 38411 P.O. NO. TERMS LOCATION PROJECT Net 30 Prkg Lot ITEM DESCRIPTION RENTAL PER QTY RENTAL PRI... AMOUNT Drums Drums: Daily Rental 03/16-04/06 16 .75 264.OOT Caution 1 R Caution Tape 200 ft. 03/16 1 5.00 SOOT Delivery Char Delivery Charge 03/16 1 12.00 12.OOT Pickup Pickup Charge 04/06 l 1?.00 12.OOT Sales Tax 20.51 Tota I $313.51 To ; Dubuque Bible Church 3500 Pennsylvania Avenue Dubuque,lA 52002 f 1 f-~:.1Q.rr~ VG,r~ rx~rsdea Contract :4374331-40 Dubuque Bible Church Patching River City Paving P.O. Box 1430 Dubuque, IA 52004-1430 INVOICE Invoice #: 4300000310 Date: 04!27/07 Application #: 1 Customer Number: 430109 Contract Item Quantity U!M Unit Price Total 1 Machine time, trucking core out, trucking rock in 0.000 LS 0.00000 1,710.00 2 3" - 6" breaker run 75.820 TON 6.50000 492.83 3 Recycled asphalt millings 67.110 TON 6.50000 436.22 4 Traffic control 0.000 LS 0.00000 205.70 Total To Date : 2,844.75 Plus Sales Tax : 0.00 Less Retainage : 0.00 Less Previous Applications : 0.00 Total Due This Invoice : 2,844.75 Page 1 of 1 RECEIPT SELCO INC. Barricades Road Signs Portable Toilets Dubuque, Iowa 52003 Phone 563 556-2434 Blue Grass, Iowa 52726 Phone 563 381-1818 3 ' l ~ ' ~ ~ DATE CUSTONEQ _ t~.,(,t,tAt,t,x. • ~ ~L~,wt~- 35~ P~~.~s.~l~~,,,.st,~. ~.bw~~~ Sa~D ~ P.0. N0. JOB N0. LOCATION ~^~- ~ OUT i EQUIPMENT i IN ~ ~ BARRICADE • FLASHER ~ ~ ~ BARRICADE • STEADY BURN ~ TYPE 111 BARRICADE FLASHERS ~ ~ HI INTENSITY LIGNi ~ RCA I OlR 1 FLAG I RCIA I ~ ~ I l 4 i I I I I I I X i RCIA ~ RCLA i ~~ i~ I 1 4 1500 11000 I R_ I R -I I I I I I I I _I _-1 I I 3 i RDCL ~ RCTT ! RWA i ~~~ i ~ x ~- I I_3_I 1 1 1 R-!_ I I I ~ lQ 1 LXwy+tid I~ l~ l ~ ~ SANDBAGS ~ 28" CONES ~ ; ARROW BOARD ~ SAFETY FENCE N ~ STOP 8 SLOW PADDLE ! ~ PILOT CAR FOLLOW ME i ~ ~ ~ PVMT MARKING TAPE 'YEL 'WHITE ~ I I i I I ~ I DELV. & SET HARGE RGE P.U. DATE c-F le • ACCEPTANCE: The undersigned accepts exclusive rontrol of the above designated equipment and acknowledges that as a condition to this sale or rental, Selco Inc. its agents or successors for any expenses or liabilities by reason of said equipment, its condition or use; and. Selco Inc. makes no wsrranty of fitness or usage, express or implied. Accepted by: