Claim Kuhle, ChrstineCLAIM 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 W. 13th St., Dubuque, IA 52001. It will then be referred by the City Council to the appropriate department for investigation. 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: Christine Kuhle
2. Address: 2180 Carter Rd., DBQ, IA 52001
3. Telephone Number: 583 8309
4. Date of Incident: JJan 14th
5. Time of Incident: 2:40 P.M.
6. Location of Incident (Be specific): In front of my drive way
7. DESCRIBE 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.)
The Street in front of the drive way had sunk down from 3 1/2 to 5 in. as it sloped down the hill.
8. What were weather conditions like? cold, wet
9. Give name and address of any witnesses: Stevel Clewell (landlord), 3500 Eagle Point Ridge, DBQ IA 52001
10. Did police investigate? (If so, give names of officers.) No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
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.)
Yes, my car. When backing my car up into the driveway my muffler caught and bent. The driveway store area has been sinking down.
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
15. What amount do you claim from the City of Dubuque?
$179.55
16. Why do you claim the City of Dubuque is responsible?
I had called and my landlord had called 3x's complaining of having problems getting into myu driveway. (I complained to my landlord about this at first because I didin't know what to do.)
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 22nd day of Feb. , 2002.
/s/ Christine Kuhle
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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 W. 13th St., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for investigation.
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: ~-~. ~_ ~O_~
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
7. DESCRIBE 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.)
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (if so, give names of officers.)
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.)
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?
16. Why do you claim the City of Dubuque is responsible? '~-- ~;'~d~ O_c~'~\~ d~'~
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 at Dubuque, Iowa this ~. day of ~--~ , 20 ~.
~ 6~ (Signature)
Un~ ~ ~Print Name)
(Rev; 1/00 & 7/01)
Kurt s Auto
1750 Radford Rd.
Dubuque, IA. 52002
Phone - 563-557-5021
ESTIMATE #
ESTIMATE FOR SERVICES
Kuhle, John
2180 Carter Rd.
Dubuque, IA 52001
Home 563-583-8309 Ext home -- Office 563-590-8302 Ext cell
Cust Id: 70
Par~ Description / Number Qty List
muffler
1
Shop Supplies
t.00 134.40
Estimate Date: 02/20/2002
1989 Mercedes-Benz - 190E
Lic #: Odometer In: 0
Unit #:
VIN #:
Extended Labor Description
repMce muffler
134.40 replace muffler
5.00 Hazardous Materials
Extended
261~9
3.00
Parts: $139.40
Labor: $ 29.99
Tax: $10.16
Total: $179.55
I hereby ataJaorize the above repair work to be done along with the necessary material and hereby grant you and/or your employees
permission to operate the vehicle described for testing and/or inspection. Express mechanic's lien is hereby acknowledged on above vehicle
to secure the mount of repairs thereto. SMOG: I understand that I can have emission service and/or adjustments done elsewhere. I hereby
vmive this fight,
TEARDOWN ESTIMATE: I understand that my vehicle will be reassembled within days of the date shown above if I choose not to
anthoriz~ the service recommended. Alt Parts removed will be discarded u~less instructed otherwise: Save all Parts . NOT
RESPONSIBLE FOR LOSS OR DAMAGE TO CARS OR ARTICLES LEFT IN CARS IN CASE OF FIRE, TI-~FT OR ANY OTHER
CAUSE.
SIGNATURE ................................................................................................. Date ......................................... Time .........................