Claim by Holiday Inn_Mike MooreTHE CTTY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL '11~"_ '`
CITY ATTORNEY
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
October 30, 2007
Claim Against the City of Dubuque by Holiday Inn Dubuque, filed by Mike
Moore
Date of Claim
Holiday Inn Dubuque
10/26/07
Date of Loss
Summer 2007
Nature of Claim
Property Damage
This is a claim in which the claimant alleges that the sprinkler line and a chunk of
concrete at the Holiday Inn Dubuque were damaged during the Historic Old Main Street
- Lighting & Sidewalk Replacement Project.
According to Gus Psihoyos, City Engineer for the City of Dubuque, Portzen
Construction, Inc. has been retained by the City of Dubuque Engineering Department to
complete the Historic Old Main Street -Lighting & Sidewalk Replacement Project. The
contract called for the standard form of contracts and bonds with the City, which require
the contractor to hold the City harmless from any claims of damage resulting from the
work.
It is therefore the recommendation of Gus Psihoyos to refer this claim to Portzen
Construction, Inc. for its consideration. The City Attorney's Office concurs with this
recommendation.
BAL:tIs
cc: Michael C. Van Mitligen, City Manager
Jeanne Schneider, City Clerk
Gus Psihoyos, City Engineer
Holiday Inn Dubuque
Portzen Construction, Inc.
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
10/25/2007 THU 14:21 FAX
Claim Form
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Page 1 of 2
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CI..AIM AGAINST THE CITY OF DUBUQUE, IOWA ~®~
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This written report constitutes your claim against the City of Dubuque, Iowa. You should complete this form in
foil and attach any additional information that supports your claim.
The claim must be filed with the City Clerk at City Hali, 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 Councl. 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 represenjjt~,ati~~on to,,y~ou as to whether your claim will or will not be paid.
1. Name of Claimant: „~+ K..~ ~,6,~i^ifg,~f~.~,.~~
2. Address: ~ S ~ f~rsk ~~ ST
3. Telephone Number. J~t•O ~ S~fc ~rJUU P~C'1` L [7 Z
4. Date oflncident: (9J4~ SLCwtYYia-f' ~-~I~i.-+ ~+~Ic.~hrr~~..V.~Q~~~~ ~^or}«~T
5. Time of Incident:
6. Location of Incident (Be specific): ~ Th 5 7'ree~ /ks T h3 r~ay rid ~ n la^~ az
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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 conditions likd~ _
9. Give name and address of any witnesses: ~ mi,.,.ti b~-
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10. Did police investi__ga/!te? (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? (tf 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 do you claim, if any? ,~o bi/l•
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10/25/20Q7 THU 14:21 FAX
Claim Form
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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. What amount do you claim from the City of Dubuque? ~(~ S 7r ~"~~~c • ±^ U~'~
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16. Why do you claim the City of Dubuque is responsible? ~.U~K r1- e~ ~~
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17. Have you made any claim against 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?
Dated this f D~day of ~c~-t3 . 20~•
(Signature)
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(Print Name)
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