Claim by Jeff JonesCity of Dubuque
City Council Meeting
Consent Items # 02.
Copyrighted
August 19, 2024
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Josh Heisdorf for vehicle damage; Jeff Jones for vehicle damage;
Tishana Suiter for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Josh Heisdorf Supporting Documentation
Claim by Jeff Jones Supporting Documentation
Claim by Eric and Tishana Suiter Supporting Documentation
CLAIM 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 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: 'A;,,/, es
2. Address: 996/ A`a jc- ►` id L Dr,
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City: CifitAir 1-G //� State: 14 Zip: ?/vJ
3. Telephone Number: 319
4. Date of Incident:
5. Time of Incident:
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6. Location of Incident (Be specific): G /0, I1iiJ/e/ Rq!9 fitypin) N scil Po"
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.)
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8. What were weather conditions like? C I eei ✓ S CA j4 H y/ /, ye. )-).1 Pi/;/ , 7' `‘
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9. Give name and address of any witnesses: / / f,., 7Lwc' /{,?IS1 Sq t %1dt $'S
10. Did police investigate? (If so, give names of officers.)
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11. Was anyone 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 clairh, if any? it/4.
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 mount do you claim from the City of Dubuque?
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1 Why do you claim the City of Dubuq a is responsible?
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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.)
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
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Dated at-at-Lb.i.latFercts, Iowa this /2'I-1day of fy,ft j7 , 20.V
(Signature)
(Print Name)
(Rev. 5/18)
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