Claim, McIntyre, RobertCLAIM AGAINST THE CITY OF DUBUQUE
This written report constitutes your claim against the City of
Du_buq~e, Iowa. You should comp~lete 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 Street, Dubuque, iowa 52001-4864. 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 Au'A~ORITY TO MAKE ANY
REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE
PAID.
1. Name of Claimant: Robert McIntyre
2.Address: 2001 Heidi Ct.
3. Telephone Number: 319 585 1340
4. Date of I~cident: 4/13/01
5. Time: Approx. 5:15 P.M.
6. Location of incident. (Be specific) 13th & Jackson
7. DESCRIBE ACCIDENT OR OCCURRENCE ~HAT CAUSED INJurY OR DAMAGE.
(~ive full details upon which you base your claim, if a City
employee was involved, give the employee's name. )
Parked my motorcycle on the street. Street gave way under my kickstand causing
motorcycle to fall on side causing damage to my bike.
8. What were weather conditions like? cleark
9. Give name and address of any witnesses.
Amy Sauser, 1315 Jackson, Rick Arensdorf, Rhomberg.
10. Did police investigate? (If so, give names of officers.) No
11. Was anyone injured? (If so, give name,
injuries.)
address and extent of
12.
Was any damage done to proper=y? (If so, describe property
and the extent of damage. Attach estimates of damages or
describe basis for ascer alnlng extent of damage.)
Estimate attached
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 a~d ~mount paid.)
No compensated.
15. What amount do you claim from the City of Dubuque?
2425.18 plus any hidden damages
16. Why do you claim the City of Dubuque is responsible?
The street was defected. I parked my motorcycle on a clean piece of street without any holes.
The City had bad asphalt there.
17. Have you m~de any claim against anyone else for damages as a
result of this incident?
If yes, give name and address:
18. If the answe~ to ~d6s~ion 17 is yes, have you received any
payment from that source, and if so, in what amount?
Dated this 18th day of May, 2001.
/s/ Robert McIntyre /
~ (Si~ature) ~
(Prin~ N~e) ~
(Revised Januaz'y, 2000)
WtL~E,qTS
LEVER, ~UTCH
Lg~'l~ ~LqS¥u FR T
COVE~ F~ Uq
~R~ FOOT~ST~ k
~T g~q~Y
~ ~ZP ~ 3% 49
~ S2P i
B~fors T~x To~4l ~887.91