Claim by Josh HeisdorfCity 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
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CLAIM 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 Clerk 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.
1. Name of Claimant:
2. Address:
3. Telephone Number:
4. Date of Incident:
5. Time of Incident: ,, ,, .
uiy Z,
6. Location of incid t e �Il`f)John Drive in Dubuque, IA
7 a= DESCRIBEQ ACCIDENTe„OR OCCUR9RENCEm THATa CAUS,EDa INJURYYQORheYDPAMAGE.,, (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:
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.)
Yes, insureds 2020 Toyota Camry
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.)
Our insured's damages have been handled.
15. What amount do you claim from the City of Dubuque? $12, 1 08.1 5
16. Why do you claim the City of Dubuque is responsible? Our insured was
stopped at the time they were struck by your garbage truck.
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
day of , 20
(Signature)
Josh Heisdorf
(Print Name)