Claim, Scales, DelmarCLAIM AGAINST THE
CITY OF DUBUQUE
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 C!aim mush be filed with the City Clerk a= City Halt, 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'raORITY TO MAKE ANY
REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE
PAID.
1. Name of Claimant: Delmar Scales
2. Address: 1611 N. Algona
3. Telephone No. 556 3576
4. Date of Incident: June 3, 2001
5. Time: 3:30 P.M.
6. Location of Incident: Decorah and Algona - Car Parked on Decorah
Location of incident. (Be specific)
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED IN~uI(Y OR DAMAGE.
(Give full details upon which you base your claim, if a City
employee was involved, give the employee's name.)
Car on Decora going up Algona (RT) spinning tires on gravele and rocks that cululated in curb corner - spraying house & car windows.
O?F' '
8. What were weather conditions lake? . ¢"t'7'~./. . . . 7/?.
9. Give name and address of any witnesses. ,~,l~ f.
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give name, address and extent of
injuries. )
12.
Was any d~mage done =o property? (If so, describe property
and the extent of damage. Attach estimates of damages or
describe basis for ascertaining extent of damage.)
Yes, Car Window Windshield & Storm Window
13.
14.
What other damages do you claim, if any?
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 ~moun= paid. )
15. What amount do you claim from the City of Dubuque?
$150 to $200
16. Why do you claim the City of Dubuque is responsible?
Because the ramp for handicap is collecting gravel and rocks when it rains the ramp is to low to drain completely
and a hazard in winter by icing up.
17. ~ ,,~ y for d~ges 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 whau amount?
Dated at Dubuque, Iowa, this 5 day of June, 2001.
20 Ol
· day of ~ l_ ~
/s/ Delmar Scales
-
(Signature) on
(Print Name)
(Revised January, 2000)