Claim Ricke, Darryl T.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 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: Darryl T. Ricke
2. Address: 16110 Oak Bluffs Ct., East Dubuque, IL 61025
`
3. Telephone Number: 815 747 2948
4. Date of Incident: 01/27/2005
5. Time of Incident: 1345
6. Location of Incident (Be specific): E. 17th & Jackson St.
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.)
Heading S. on Jackson, was going to turn on W 16th Street while driving past 17th St.
I saw the truck at Stop Sign, so while driving past 17 Street looking forward, that's when
he hit my front end of my truck (David Peter Haupert) off Duty Officer. He called the accident in.
8. What were weather conditions like? Sunny, Pavement dry.
9. Give name and address of any witnesses: Michael Ricke, Jerod Freese, Alex Chorak, Tyler Vandsnider, Students of Nativity BVM School, E. D. IL
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Ehler
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
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.)
Front Bumper, Right Front Corner Panel; Right Front Wheel Hub;
13. What other damages do you claim, if any?
None
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.)
No
15. What amount do you claim from the City of Dubuque?
$1,348.25
16. Why do you claim the City of Dubuque is responsible?
Because it was a Police Officer hired by the City of Dubuque that hit my 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 11 day of February, 2005. , 20 .
/s/ Darryl T. Ricke
Darryl Ricke
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
-
.
''> -
1/ , ; / / A; .' /
j ..>;,f/ L/.../I'/-'// % (/- ;
~/;/;'-/f.- -. /-.'/ --". "- -, /
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 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:
OAP.RYL /. K/r2.f\E.
2. Address: /6//0 OAk 8L UFf5 c.T. C175r PI/oc'auE IL 61r72)~
3. Telephone Number: 8Jf. 1(1.('7. ). 918
4. Date of Incident: 0 I /:z 7 I;). 0 0 :J
5. Time of Incident: / 3 I( 5-
6. Location of Incident (Be specific):
E, t'l7H fJACf:.So)J STReff
.
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.)
HEACI/I/<:!! S, OIJ J!tC-f<.50;), (,VIIS GOI/vb 70 rVIi# all W /~ 5T/?,EET
j
tu/fIi.E DRlv/PC PM! 1'7 ff{ I SAW THE rf<UCk Al 'Jlo!' 5tGP, so VJHILe PRIIIING
fA>? II] 51flf-E-r [.00/\ IIVG FORwIrRfJ, -rH/tf5 VJHIEP HE HIT/Y7Y r/?/J//7 F~O d~/J1>' rfi'tJcf(
(O/J V ro PElf R, H AU PE RI J oFF Wry OFFICF- RJ HE. eAU E lJ THE A a. IPF-/.IT I /V.
8. What were weather conditions like? S () JCJ j,/ Y., P/11/ f !'II E. PT 0 R Y
9. Give name and address of any witnesses: fY!ICH.1E L RI vAt) J fl? 00 F/?EEse,
AL.EX c.HORIiK) TYl..[f\uJANVy,IJIHR.} STuIJE,JIT5 of'/V4TfIlITi f3v,M 5CHoOL,c /JIL.
10. Did police investigate? (If so, give names of officers.)
Yf- 5, OFFicER EHLER.
,
11. Was anyone injured? (If so, give name~, addresses, and extent of injuries).
No
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.)
F {ION T BUM fER A tG I-IT FROP, CORP If? PAfiI ~ 1- J {<" G Hi fRo)./7
J -
(JJHHL /-Iuf3
13. What other damages do you claim, if any? )J a jJ f
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.)
NO
.
15. What amount do you claim from the City of Dubuque? ,f~ 3'1 't. :l )'
16. Why do you claim the City of Dubuque is responsible? 8 E C Ii u 5' E (T rJJ A S A-
PO((CE OFF/GER I-II(1EO 13 Y THE CITY OF Ov!3UQuC THAI !-lIT
/I1Y T /?(J ell
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? IV 0
Dated at Dubuque, Iowa this
II
day of
Fc8 {JIM Y
.
, 20 &1'>.
J)rM/I:? 7 fd<.k
~ (Signature)
i/A/f!?(C. l1/c/(E
:J (Print Name)
. ._, _.." I ~
\
_:(.1
(Rev. 1/00 & 7/01)
MA&Form e33093 lows eperhnet Ta � Iowa Department of Transportation
Of-0! lone Dapartmant of Trenapartapdrl
Office of Driver Services
Park Fay Mali, 3ttO Ettdd Moms
P.O. Box B204
Da* Moines, Iowa -9294
N
TYOR NT
INVESTIGATING OFFICER'S REPORT
OF MOTOR VEHICLE ACCIDENT
V7 i okt ►]al/ids car 1 ee91k�iasoorr( j ilhin �14601
if accident . -. ad outside W N NE E SE SW W NW
city tlmlla show general vicinity mree 0 0 0 0 0 0 0 0 of nearest city
On Road, Street, D-
Al
Intel e:lion
with: E! J7
Note: Unless accident occurred at en Intersection WWI Ia completely described shove, use the space below to give Ella exact Iocetton from a rrnepora
or del neble Intersection, bridge, Of railroad creasing, using two distance and directions if necessary.
Feet
Meager
Number
Mites a vas 00 0 0 NW0 end Feet
17eRnetde intersection,
Or bridge, or nslk0ed meeting
Driver; Naha (Last, Firm'. Mudd
IA "+ AV Pc 1'erz
Mans Female Close Endorsements
0
l
Owner me (Last, Firm -Mamie)
• ?lamvr2,
Reetrtca on
Address
Citation
Charge
2.
ar
i oac 66carv0a
Rv[t)--- . 6/
A Ncohof • f I. None 3. Udne 5. Vitreous Test Results:
v Ter f3iven711 2. Stood 4. Breath 9. Refused
Addreas
itekne tine Co. kG l ifit41t 4 Y+i 1- A+44I e eitn:wence
n
2 GCeKJgvl'flh7/313 �o9
D too Torrevet
u
Vehicle
l''IJ.
Action
Ll�1 L 1
TGtaEr+L;, :;.;j' y Traffic
Ca:apatite '� E f CGntrple 1 1 )
CtirTuneretel Tr9beT 'Mantled to
Scene, Piste tF Power tlfllt:
Point 01
InMlal Impact
Vehicle
Conti g. I 1 I
LLJ
Type LLJ
'fir i.
l'itemitt;
L1JL
Most Damaged Extant of
Area
Vette* 1 , LJ1
Defeat L
State Yee' Attached to
Trait* Unit
Address
vs ro 1 1 1 l 1 1 J[ Aloe
D s ante (Last, Firs! ) •
rr I
Mariana '{Lint, First, Middle)
r(.)eft I 81i0 v /00
s1
4,
Sheet ■ of
Lew Enforcement Ca N' rn en,
9T2.6
kepi
intervention? ❑
Private
PropertY7
County: Route'
X-Coordinate:
Y.Cowdlnem: f
tf Divided Hiphv9ey, Prvide Route
(Cerdinal) jyivel Direction
0 0 0 0
Drug 1. None 3, Urine Fos. Neg.
Teat Given? LJ 2. B10011 9. Reiu9ed 0 0
e1
Unde►rldef, . ,
fvesrtde
Drhror Vekon
C I:Xi U O, cured I 1
Taw 9
Private?
z
Cptioo,
Yri
OpprosenatsCosito
Rupee or Replace
Contrlbutng Circumstances,
Driver (uL.
p e7 two) il I I I
B4nae Year Emergency
Vehicle ' r
Slatul
PIaG'ITd # + • FimiYarde la iJrlaAWe ^ .
[TO ° fihr-i-5 021Y E A,414,rr4
Citation ,t,
Charge
orals Vehicle - • -
Weight Rating
3
2. 4.'
l
` 1. Nome 3. Urine Q. Vitreous Teal l3asult : Drug I. 3. )one
Teal Given? IJ 2. Blood 4. Breath' 9. Refused Test Glven7 /U 2. Bided 9. Reivaod
Alcohol
Address city 9tetg
InwrartreiCA4rt1. iity h S. } titre.{14 % ,;C < Policy*c /+L, 4
Neeaa L GG
"N2 60E 14 icTila lJ 37Db
Inlaid Traver Vetecie ' Speed taint at
Oiracllon 1J(A c { . LkratI L J 1 htld& Inland LIJ
Occupants Ulf f Conti nfs 1 J
Total
Vettcie I
Ccnflg. LLJ
ZWZr75 A4 tOt-
M ptine6Q
ce
Most Damaged
L
p. •
T L L1
type••.
LLJ
Vehicle
Daled
C;ornmerctel Trailer Attached to State Year Attached to
License PIafe # Power Unit: Trailer Wit'
Canter
Name
p 7a °` 0 I i I J I I
If Property other than
vehicles damagedwent
Owner's Frdt Name
(Leat. First. Mbddis)
Street or
RFD
Ohtani
Damaged
ACCIDENT ENVIRONMENT
Number
of Axles
Location of Filet Harmful Event U Weather Conditions l I I
tap to two)
Manner at CresiVC011fBlon
Light Conditions
u
LJ Stirrer* Caidrtens
LLJ
u
Address
City, State,
Zip Code
Extent of Undmririel
Damage Override L-J
Driver VisJort
Condition Obscured Obscured 1 1. I
Gross Vehicle
Weight Rating
Estimate of
Damage 5
Tow Y
Private?
Poe., Neg. .
Q' d_
Apprtm'mete Call to
Raoaa or R.Msce a
C"C#] L%
Contebating Ciraunetanrala.
Driver {up to tWO
Stets Year
cow
Emergency r Emergency 1
Vaticle Typa) lStatus 1J
City S7eta
Placard .J_
Was owner or 5 - Yes 9 • Unknown
tenant notified? Li 2 - No
ROADWAY CHARACTERISTICS
Major Contributing Circumstances:
Envtrcrtmerd
Roadway
u
w
Type ot RoarWay Junction?Featre I I J
WORK ZONE RELATED?
QYes 0No
Li Location
1J Type
tJ Workers Present?
I4arerdocea Materiels
Released?
ZIP
Unit 1 Unit 2 SEQUENCE or EVENTS
LLJ U J
LLJ LLJ
LLJ LJJ
LLJ w
LLJ LLJ
Firs! Event
Second Event
Third Event
Faurlh Event
Most Hermeuf Event
lby vehicle)
r I I First Hennfol Event of Crash
J (use codes i 1-42 only) j
/
Damage Assessed By: Randy Beadle
Deductible: 0.00
Claim Number: NA
Kieffer Body Shop
20100 us 20 WEST EAST DUBUQUE, IL 61026
(816) 747-3044
Fax: (816) 747-3044
Tax ID: 38-3028967
Owner DARRYL RICKE
Address: 16110 OAK BLUFF COURT EAST DUBUQUE, IL 61026
Telephone: Home Phone: (816) 747-2948
Mitchell Service: 916489
Date:
Estimate 10:
Estimate Version:
Preliminary
ProfilelD:
Description: 1998 Chevrolet Pickup K1600
Body Style: 2D PkupXCb 8' Bed 166" WB Drive Train: 6.7L Inj 8 Cyl4WD
VIN: 2GCEK19R2Wl163726
Options: 4WD OR AWD, ALUM/ALLOY WHEELS, AIR CONDITIONING, POWER WINDOWS, POWER DOOR LOCKS
CRUISE CONTROL, AUTOMATIC TRANSMISSION, AM-FM STEREO/CDPLAYER(SINGLE)
Line Entry LallOr
Item Number Type
1 646607 lUlY
2 600940 BDY
3 546452 BDY
4 612370 BDY
6 AUTO REF
6 612800 BOY
7 614740 BOY
8 900600 MCH"
8 AUTO REF
10 933006 BDY
11 833018 REF
12 AUTO
13 AUTO
Operation
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/lNSTALL
REPAIR
REFINISH
REMOVEIINSTALL
REMOVE/REPLACE
ALIGN
ADD'L OPR
ADD'L OPR
AOO'L OPR
ADD'L COST
ADD'L COST
Line hem
Description
FRT BUMPER FACE BAR
FRT BUMPER IMPACT STRIP
R FENDER WHEEL OPENING MLDG
R FENDER PANEL
R FENDER OUTSIDE
R LWR FENDER ADHESIVE MOULDING
WHEEL
FRONT END ALIGN
CLEAR COAT
RESTORE CORROSION PROTECTION
MASK FOR OVERSPRAY
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
. - Judgement Item
# - Labor Note Applies
C - Included In Clear Coat Calc
ESTIMATE RECALL NUMBER: 2/31200616:22:19 2173
UttraMate is a Trademark of MitchelllnternatlonaJ
Mitchell Data Version: JAN_06_A Copyright IC) 1994 - 2003 Mitchell International
Ultra Mate Version: 6.0.031 An Rights Reserved
Part Type!
Part Number
16674112 GM PART
ORDER FROM DEALER
Existing
Existing
12360632 GM PART
Sublet
2/3/200503:25 PM
2173
o
Mitchell
Dollar
Amount
220.80
41.40
620.16
0,00 ..
6.00.
6.00 .
100.80'
4.00 ..
Labor
Units
1.4 #
INC #
0.2
1.0'#
C 2.8
0.2.
0.3
1.9"
1.0.
Page 1 of 2
~
Date:
EslimalelD:
Estimate Version:
Preliminary
ProfilelD:
2/3/200603:26 PM
2173
o
Milchell
I. Labor Subtotals
Body
Refinish
Mechanical
Units
3.1
3.6
1.9
Rate
45.00
45.00
53.00
Add'I
Labor
Amount
5.00
5.00
0.00
Sublet
Amount
0.00
0.00
0.00
Totals
144.50
167.00
100.70
II. Part Replacement Summary
Taxable Parts
Sales Tax
@
6.260%
Amount
782.36
48.80
Total Replacement Parts Amount
831.25
Non-Taxable labor
412.20
labor Summary
8.6
412.20
m. Additional Costs Amount IV. Adjustments Amount
Nonw Taxable Costs 104.80 Insurance Deductible 0.00
Total Additional Costs 104.80 Customer Responsibility 0.00
I. Total Labor: 412.20
II. Total Replacement Parts: 831.26
m. Total AddKlonal Costs: 10UO
Gross Total: 1,348.26
IV. Total Adjustments: 0.00
Net Total: 1,348.26
This is a preliminary estimate.
Additional chanaes to the estimate maY be reauired for the actual repair.
ESTIMATE RECAI.L NUMBER: 2/31200616:22:19 2173
UttraMate is . Trademark of Mitchelllnl.rnalloRal
Mllchell Oala Version: JAN 06 A Copyrlghl (CI 1994 _ 2003 M/lchelllnlem8llonal
UltraMate Version: 6.0.031 - All Rights Reserved
Page 2 of 2