Claim by David Weydert Copyrighted
October 2, 2023
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Jill Boge for vehicle damage; John Eby for vehicle damage; David
Weydert for property damage
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Jill Boge Supporting Documentation
Claim by John Eby Supporting Documentation
Claim by David Weydert Supporting Documentation
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CLAlM AGAINST THE CITY OF DUBUQUE, IOWA
This writfien report constitutes your claim against tt�e City of Dubuque, lowa. You shoufd
complete this form in full and attach any addit�onal informatian that su�ports your claim.
7he Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, �A 52001. It
wi�l tF�en �e referred by the City Council to the appropriate department far in�estigation.
Once that inve5tigation is completed, a report and recommendation will be suE�mitted to the
City Councif. You will be provic�ed with a copy of that report and recommendatian.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNC�L. NO EMPLOYEE OF
THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY R�PRESENTATION TO YOU
A5 1"O WHETHER YOIJR CLAfM W[LL OR WILL NOT BE PAfD.
'�. Name of Claimant: �:��:. � �
2. Address; �7 � � ,�j . C ' ,
City: ;� - 5tate: .��� Zip: h�� �1
3. Tele��one Number: ���� � � ` ���
4. date of Inciclent: �;� (� � �
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5. Time af Incident: C� �_ ,� � � �.�f�
6. Location of Incident (Be specifc): �r� ��c�,�'T�D��- �[S�.
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7. DESCRIBE ACCIDENT OR OCCURRENC� THAT CAUSED INJURY OR DAMAGE. (Give
fu11 detaifs upan which you base your claim. if a City employee was in�ot�ed, gi�e the
empfoyee's nam�.)
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8. What were weather con�itions like? �� � " 1 �` L�_
9. Give name ancl address o� any witnesses: ��, � l��'���� ��' � � � �����/�'��S,
� ��'Jt�� C,-����i�� � ���d t.�i��iV
1Q. Did po�ice in�estigate? {If so, give names of officers.)
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11. Was anyane injured? {If so, give names, addresses, and extent of injuries}.
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12. Was any damage done to property? (If so, d�scribe property and the extent of
damages. At�ach estimates of damages or describe basis for ascertaining ext�nt of
damage.}
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13. What other damages do yvu claim, if any? _��'�4 ��`� �-
14. Have you been compensated for any part or alt of your claim by any insurance
com�any? (If so, gi�e name and addres� o# �nsurance comparty �nd amount paid.)
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15. What amount do you claim �rom the City of Dubuque?�
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16. Why do you claim the Ci#y of Du uque is res.ponsible? I f 7
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17a Have you mad� any claim against anyone else for damages as a result of this incident?
(1f yes, give name anc! acldress.)
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18. If the answer to Question �7 is yes, Y�ave you recei�ed ar�y payment from that source,
and if so, in what amount?
Dated at Dubuque, lowa this �� day of _��'�'�����N ���� , 2p ;� �
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� Ct L�� ��:����� , �Signature}
�� �"� e' �,�[/„� +lrl ra j��, (Print Name) _
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