Claim by James NewmanTHE CITY OF
DUB E
Masterpiece on the
BARRY LIND
CITY ATTOR
To:
DATE:
RE:
Claimant
MEMORANDUM
Mayor Roy D. Buol and
Members of the City Council
October 16, 2007
Claim Against the City of Dubuque by James Newman
Date of Claim
James Newman
10/05/07
Date of Loss
09/01 /07
Nature of Claim
Property Damage
This is a claim in which the claimant alleges that a tree limb fell from a City tree onto the
roof of claimant's vehicle, damaging the 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
Jeanne Schneider, City Clerk
Gil Spence, Leisure Services Manager
James Newman
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 / EnnAIL balesq@cityofdubuque.org
~~~~
Y OF DUBU UE IOWA ~ ~
CLAIM AGAINST THE CIT Q ~ ~~~
onstitutes our claim a ainst the City of Dubuque, Iowa. You ~~~~~~~
This written report c y 9
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
3. Telephone Number.
4. Date of Incident:
5. Time of Incident:
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6. Location of Incident (Be specific):
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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 nar,~e.)_ ,-. r~ ~ _ _ _-~- ~;~, S ~~
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~. Give name and address of any witn sse S ' ~ ~ ~ n
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10. Did police investigate? (If so, give names of officers.) ;/ ;
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8. What were weather onditi ns like?
11. W~ anygne injured? (If so, give names, addresses, and extent of injuries).
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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 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.)
15..What amount do you claim from the City of Dubuque? ~ ~ ~
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16. Why do you claim the City of Dubuque is responsibl ?
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17. Have you made any claim against anyone els for damages as a result of
this incident? (If yes,' give name and addr
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 y ~ ~~ `~
(Signature
(Print Name)
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HART AUTO BODY & PAINT
800 CEDAR CROSS ROAD DUBUQUE, IOWA 52003
PHONE: (563) 556-8323 FAX: (563) 556-8324
DAMAGE REPORT
PRICES SUBJECT TO CHANGE
Items CIRCLED are not in the total in
our opinion, are not part of this claim.
VE I~~ wNJ R_- ..r,~lm OV l u ,73 +., tid h• `~--f-~_ ~ ~.` .~ -••-- p../ U,--o ~
Y ~ ~ M ~ ~S~ ODEL LICENSE MILEAGE ~~ Rr ~ SERIAL NO. CONDITION
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INSURANCE CO ADJUSTER PHONE CAR LOCATED AT DEDUCTIBLE
FRONT
sym.
of Pa1et
of H~our;s
Parts
sym. LEFT
of Paint
or Hours
Parts
sym. RIGHT
of Paint
or Noun
Parts
Bumper W/Pads Fender, Frt. Fender, Frt.
Bumper Abs. Fender Shield Fender Shield
Fender Ext. Fender Ext.
Fender Mldg. Side Fender Mldg. Side
Fender Stripe Fender Stripe
Fender Mldg. Fender Mldg.
Bumper Reinf.
Bumper Brkt. Side Light Asmbly Side Light Asmbly
Bumper Cushion Headlamp Headlamp
Valance Headlamp Door Headlamp Dr.
Bumper Gd. Sealed Beam Sealed Beam
Frt. S tem Park Light Park Light
Frame Cowl Cowl
Cross Member Door, Front Door, Front
Wheel Door Hinge Door Hinge
Hub Cap Disc Door Panel Door Panel
Lr. Cont. Arm Door Stripe Door Stripe
Door Mldgs. Door Mldg.
Up. Cont. Arm
Center Post Center Post
Door Rear Door Rear
Bumper Filler Door Mldg. Door Mldg.
Grille
Grille Panel
Grill Panel Mldg. Rocker Panel Rocker Panei
Rocker Midg. Rocker-Midg.
Floor Floor
Dog Leg Dog Leg
Quar. Panel Quar. Panel
Air Condenser Quar. Ext. guar. Ext.
Recharge System Quar. Wheel House Quar. Wheel House
Name Plate Quar. Midg. Side Quar. Midg. Side
Baffle, Upper Quar. Midg. Quar. Midg.
Lock Plate, Lr. Quar. Stripe Quar. Stripe
Lock Plate, Up. Side Light Asmbly Side Light Asmbly
Hood Top Tail Light Tail Light
Hood Hinge REAR MISC.
Hood Lock Bumper Inst. Panel
Ornament Bumper Abs. Front Seat
Rad. Sup. Bumper Cushion Front Seat Adj.
Rad. Core Bumper Reinf. Top ..r
Anti Freeze Bumper Brkt. Headlining
Rad. Hoses Bumper Gd. Top Vinyl
Fan Blade Bumper Filler Tire % Worn
Fan Shroud Valance Painting
Fan Belt Lower Panel Aerial
Water Pump Floor Rust Proof
Water Pump Pulley ,S Trunk Lid Battery
Motor Mts. Trunk Mldg.
EPA WASTE DISPOSAL CHARGE .f : O D
Lic. Light PARTS (Prices Subject To Invoice) _
@ R HR.
SERVICES ~ HRS I- . O a
- .
G ,
i
d
i SUBLET OR PAINTIN
W
n
sh
eld Gas Tank _
Frame SUB TOTAL 1 yy ~ ~
Wheel TAX - ~
Hub & Drum PAINT-MATRL-HDW. a. ~ ~• ~
Axle
in
s
_ g
pr GRAND TOTAL ? g . Q
Appraiser X
Symbols: A-Align N-New OP-0pen P-Paint 1 HEREBY AUTHORIZE THE ABOVE REPAIRS
S-Straighten R-Replace OH-Overhaul