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Claim by Jwan BrookinsBARRY A. LINDAHL, CITY ATTORNEY MEMO To: Mayor Roy D. Buol and Members of the City Council DATE: May 23, 2007 RE: Claim against the City of Dubuque by Jwan Brookins Claimant Date of Claim Date of Loss Nature of Claim Jwan Brookins 05/18/07 05/17/07 Vehicle Damage This is a claim in which the claimant alleges that as he was driving behind a City of Dubuque recycling truck in the alley behind Cafe Manna Java located at 269 Main Street, the recycling truck stopped and began to back up, striking claimant's vehicle. 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 ~J'eanne Schneider, City Clerk Don Vogt, Public Works Director Jwan Brookins OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 30O 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: 2. Address: 3. Telephone Number 4. Date of Incident: ~)i~~t ~-A~L1 ~ ~ ~c~ol~l-~~ z/ l~ ES i 5?'a lJul 4'J~ _r ~~'~ ~0 `~ i~Z~~;~ ~~~~ ~~~~ 5. Time of Incident: `~ ~ ~J AM Location of Incident (Be 111 Tl~ ~ A Lt.,EY 'To ~ ~iE -ski yr - G p~~JIQ KIT 1{ts ~~5~ A-vD -Mi?~w. ar- u-s ~ ~rJ ~/~5~. i PR~S~D My ~r~s r~rti D 8. What were weather conditions like P-~~~HEI~ Fc~z R~V~SE ~~ 'SEFc~~ ~ ~~~~ ~~ rr ~- S ~ ©~ o ~' N15 ~ ~ D ,IID RD . MRS 1/D BACK ol= uc~ t~C~ 7D Tl-1~ ~~ ~ M.Y CAS CJt~SIr~~ DA,M~~ TU 9. Give name and address of any witnesses: ~~ Hoop, r~ o W i ~ S i- F P~-Sbr~ S To r~N~ Sc-E-~1/ wRs Mk ~~c6s (~r~~G~A r~tt A~~ ~. nv~~-D cotFS ~~ ~~v~1~ 10. Did police investigate? (If so, give names of officers.) _ _^ 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.) ~AFT~4Z P1~'.k11JC~ l~,P p~tsT~2iE S & S'uPPIES ~~ T1-~~ AU_EV ~Q-~~~ 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). llc~ orJ~ ~~ [rasuRkSfl~f~` 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.) I,UI LL ~~ ~~T]ivt,~~S A~FT~- ~T~CI~-[~ C~ 1, ~a S c~P 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.) No ~ H~~ N(Yt~ 15. What amount do you claim from the City of Dubuque? ~'STlnn Jr'~15 l~1Lll.. t'9~h~1,1l~ 16. Why do you claim the City of Dubuq a is responsible? ~ Yi1~ ~E C-rY U i5 fi~.lC~ 1tJ U ~ ~ ~ ~ `-~ A~UOti~ ~cO~M[NCs YtTS~-f I C(~ ~ ~~ l ICU i1~~ FeoN ~ ~ M~ C~ 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 sour ,and if so, in what amount? n~ Dated-this y of , 20~. ~~- - C -~ ~ c~ ~ ~. °D ca '~ (~ ~ N ~UVII~ K- ~ N (Print Name) Ti Q