Claim by Julian and Shirley ReganTHE CITY OF
DUB ~ E MEMORANDUM
Masterpiece on the issis~ippi
BARRY LIN ~IFYL
CITY ATTO N EY
To:
DATE:
RE:
Claimant
Mayor Roy D. Buol and
Members of the City Council
September 12, 2007
Claim Against the City of Dubuque by Julian & Shirley Regan
Date of Claim
Julian & Shirley Regan 09/10/07
Date of Loss Nature of Claim
09/10/07 Property Damage
This is a claim in which the claimants allege that the basement of their residence
located at 704 Duggan Drive sustained water damage due to a sewer backing up on
September 1, 2007.
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
John Klostermann, Street & Sewer Maintenance Supervisor
Julian & Shirley Regan
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.org
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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: ~/r ~//,~ of ~ .Sh 1
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2. Address: ~~
3. Telephone Number ~~~jJ~~~j ~ 3
4. Date of Incident:
5. Time of Incident: f ~ ~ ~~=~ ~+?
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.)
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8. What were weather con itions like? ~~`~
9. Give name and address of anv witnesses:
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10. Did police investigate? (If so, give names of officers.)
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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.) ~ ,~ ,, ~ „ ~ , ~
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13. What other damages claim, if any? ~~. he ~ s-~
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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.)
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15. hat amount do ou cla
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16. Why _ you maim the C
from the City of Dubuq~e~
of 4ubuque is respo sible? ~ ~
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17. Have you made E~~ny claim gainst anyone else for damages as a result of
this incident? (If yes,'give name and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
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