Claim by Shane FlesherTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
~~ /"
BARRY LINDAHL
CITY ATTORNEY
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
August 14, 2007
Claim against the City of Dubuque by Shane Flesher
Date of Claim
Shane Flesher
08/10/07
Date of Loss
08/09/07
Nature of Claim
Vehicle Damage
This is a claim in which the claimant alleges that while he was trying to park his vehicle
in front of 909 Main Street, the left front tire on his vehicle was punctured by a piece of
metal protruding from the curb.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
BAL:tIs
cc: ~llichael C. Van Milligen, City Manager
Jeanne Schneider, City Clerk
John Klostermann, Street & Sewer Maintenance Supervisor
Shane Flesher
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: ~~17~r<<'~ ~ ~E'~~i~'~
2. Address: / ~ / ~ ~ ~ ~~~~~~' ~'_J/ ~~ ~ /~ ~~ ~ .y ~ J~ ' - ~-'~> _
t--~==-,
3. Telephone Number ~~,~'
/;
~,.
4. Date of Incident: ~~~ ~~~'
~ ~.
5. Time of Incident: L~ ~ 3G~ ,;~~~''~
./'/! ~~
~~~
e~~,
1~~~~
6. Location of Incident (Be spe/ry.'f~fic): ~ % ~~ ~~ ~~
~ C
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.)
,,,
9. Give name and addr ss of any witnesses:
i-/-
"G-
~,~~,/~
~~~~
~~c~
x
l~ ~,
10. Did police investigate? (If so, give names of officers.)
~~C% ---
8. What rarere weather conditions like?
}~,~~~~~
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
ir~~~ --
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 dams e.)
\ E~ j j , x wig ~ ~~~ ~~~~~~~- G~;:~ v'~'Y~ J ~ ~~~ f, y~_ ~C~
~ i ~ S z~ G'7- ~ <• ~'~~ ~ ~. a ,.ice .~c~ t« ~ , -
13. What other damages do you claim, if any?
rig ' / ~'~,"~< <~ ~ ~ ~ 1 ~-- - ~- - v/1 ,
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 aid.)
~~~=~
1 .What amount do you claim from the City of Dubuque?
.~~ /~~( ,~~c~ l~ ~ ~X ,,
16. Why do you claim the City of Dubu ue is responsible?
/ ~ /
~ ~, Q -r- C Gd / {~ ! !j / /u` >Q /G C~ac ~ ~~cz ~.,~h (/ vf' cc ~ ~ ~`G=2i~ tt "Y~ 1 `~~ C~C~T
~u ~ ~~ ~`~ ~ ~v~~~ t/~ Th ~~ ~ ~/~ Gtr /
i'~r~, ~.n .,. 4 ~ ~~~_ ~ ~ G~~. I ~ __ ~~~ L~ CJ- / ~ W c? ~ .JGC ~~ /IJ I/v`~7 CC ~„
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 ~' day of ~~ ~' ~ L S`~ , 20 ~.
~,~~ '~ ~~ngnQ
---~ .--~: J ~ ~ J ,,4 zn
(Signature)
j 9L ~ cz L 1 ,~_ ~ /~ ~ L "L~ L~~
(Print Name) ~~~~~~J~~
aee casnler for michelin registration card or visit
..,.. ..L ..I:
STORE
4200 D
DUBU
(563)58
LIC# IOV'
Servic
DATE NAME ~
08-09-2007 FLESHER, SHANE , IA ~
YEAR MAKE MODEL COL(
2001 BUICK REGAL Sih
LICENSE ODOMETER CUSTOMER ARRIVAL TIME SERVICE COP
~*****~* 67315 2007-08-09 07:32 PM 2007-08- 09 C
Service Description
NEW TIRE Whitewall - IN
- Tire Pressure -CHECKED, Ft.30 R.0 - New Tires - COMPLETE DOT: Y9XOVNUU1707
- Valve Stem -Install -COMPLETE
N/C MOUNT ONLY
-Tire Service Accepted - N/C Tire Mount
-Valve Stem Optional - NO ACTION
ONE-TIME BALANCE
- Balance (Required) -COMPLETE
TIRE HAULER FEE
- Dispose of Old Tire Accepted -COMPLETE
LUG TORQUE
Driver Front 100 FT-LB
TREAD DEPTH
Drirer Front - 0/32
Merchandise Description Quantity Unit Pr
P225/60R16 LNG TOUR 1 74.96
2 1/2 SNAP IN VALVE 1 1.75
i
Customer Comments Total (Excluding A
Technician Comments T
DISCL
.
1 hereby authorize the stated reE P
the necessary material, and here
to operate the vehicle herein de:
h
l
h
f
8
e
sew
ere
or t
e purpose of
express mechanic's lien is he 8
vehicle to secure the amount of 8
WAL-MART [S NOT RES
DAMAGE TO VEHICLE'
VEHICLES IN CASE OI
OTHER CAUSE BEYONI
II
CUSTOMER SIGNAL
HAVF. vnIIR I rIr NUTS RETOR UED AFTE R T SO
YE VALUE YOUR OPINION!
WE PANT TO KNOY A80UT YOU SHO PING
EXPERIENCE TODAY AT YAL-N T,
Please coNplete a survey about
todaw's store visit at:
http://yyy,auf`Vey,YalAlert.COa
You will Head to enter the
followtns online:
STORE 8: 2004
PASSYORD: 1627486
5257
IN RETURN FOR YOUR TIME YOU COULD
RECEIVE ONE OF FIVE :1000
YALNART SHOPPING CARDS
Must be 18 or older and a lesal
resident of the 50 US or DC to
en{er, No purchase necessary to
enter or win, To enter without
purchase and for coAplete official
rules visit
YWY ,entry , sU-'Ve}1. we l A1art , C0A ,
Sweepstakes period ends on the date
shown to the official rules. Survey
Dust be taken wtthln TWO weeks
of today.
Este encuesta ta~btfn se encuentra
en espanol en la p sine del Internet
THANK YOU
WAL~MgRT'
ALWAYS LOW PRICER.
Ate.
ST1i, 2004:1
fIRE~BALANCE.06811381
~IRE,FEE,,,,,00000370
~•••••....TLE.ITEMS.C
IlITO. BULB... , 00~iS1353~
'OOL.SET,,...006019701
........TAX.~1.,.7s001
.............. .1
...............VISA..
- 1003
TER. 95 , TRiI , 07360
~OLLOW„
2550 ~~~~""'
683......74,96.X
602......,1.75.X
632.,....,5,OO
X
.
64$, .. ,1.50.T
MPLETE.,~
)TAL... . 83, 21,
~
67 ....
4.96 , X
'
• ~tor
88 ....
16 , 94
X t ro
.
iTAI ....105.11 '°t t°
,
• • 7.36. ,
TAL..
112
47 range
~r any
l
,,
,
„
END....11Z.47, e
.
CCOUNT,80306
PPROVAL.8005917
RANS,ID.-0007222028353328
AYMENTISERVICEC-,E
88888888888888888188=888888888888888=
88#88#881}8tfx8~t}8=888~~l~g888~~8>Y8tt88t}
S ITEMS SOLO 6
riiiii~iviiiiMir'ww
?7
DATE NAME
08-09-2007 FLESHER,
YEAR MAKE
2001 BtiICK
LICENSE ODOME
~**~'~*``~' 67315
See
SHANE __ , IA
MODEL
REGAL
.TER CUSTOMER ARRIVAL
2007-08-09 07:32 PM
Service Df
NEW T[RE Whitewall - IN
-Tire Pressure -CHECKED, Ft.30 R.0
- Valve Stem -Install -COMPLETE
N/C MOUNT ONLY
-Tire Service Accepted
- Valve Stem Optional - NO ACTION
ONE-TIME BALANCE
-Balance (Required) -COMPLETE
TIRE HAULER FEE
- Dispose of Old Tire Accepted -COMPLETE
LUG TORQUE
Driver Front 100 FT-LB
TREAD DEPTH
Dri~'er Front - 0/32
Merchandise Descripti
P225/60R 16 LNG TOUR
2 1/2 SNAP IN VALVE
STORE# 2004
4200 DODGE STREET
DUBUQUE, IA 52003-0000 US
(563)582-1003
LIC# IOWA
nrd or visit Service Order:
es IIIIIIIIIIII
IIIIIIIIII
PHONE # 4857 62550
(608)558-9270
COLOR
Silver
E SERVICE COMPLETED TIME
2007-08-09 07:39 PM
Service
- New Tires -COMPLETE DOT: Y9XOVNUU1707 0.00
- N/C Tire Mount I 0.00
5.00
1.50
Customer Comments
Technician Comments
tantity Unit Price Merch
I 74.96 74.96
1 1.75 1.75
Total (Excluding Tax) 83 21
DISCLAIMER
I hereby authorize the stated repair work to be done along with
the necessary material, and hereby grant Wal-Mart permission
to operate the vehicle herein described on streets, highways or
elsewhere for the purpose of testing and/or inspection. An
express mechanic's lien is hereby acknowledged on above
vehicle to secure the amount of repairs thereto.
WAL-MART IS NOT RESPONSIBLE FOR LOSS OR
DAMAGE TO VEHICLES OR ARTICLES LEFT IN
VEHICLES M CASE OF FIRE, THEFT OR ANY
OTHER CAUSE BEYOND WAL-MART'S CONTRnI
CUSTOMER SIGNATU~
HAVE YOUR LUG NUTS RETORQUED AFTER THE FIRST 50 MIMI S
08-09-2007
DATE
t do agree and fully understand that my motor
vehicle had a low oil level when I brought it to
Wal-Mart for an oil change. This was pointed out to
me, that I willingly requested Wal-Mart to change
the oil. (will not hold V'al-Mart responsible for any
damage to my motor vehicle by the low oil level.
SIGNED
DATE
QUALITY CONTROL TECH: JASON 5027
SERV WRTR/GREETER: LORAS 4815
TIRE TECHNICIAN: RICHARD 4436
~: _If~
N.
,rN~ ,
~(y j !
t ~ i
r i. ~,,V 1
~ !!,.
~ ~ ~ ~ ~~
~ y,{t~
..s [~;
r r.'. ;
i ~ ~~~~~
f~ ,t~ tti ~~:.
i 1
1
t ~ i S,~e~fy ~~~
nit.' . ~'`(
'V/`t ~!
-1t
-rc,.e Cam- `~ C ~'°,-'~ ?~ ~~ ~,