Claim - Rieder, GeorgeCLAIM 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: George L. Rieder
2. Address: 3090 Westmore Dr., Dubuque, IA 52001
3. Telephone Number: 563 556 2719
4. Date of Incident: Sep. 25, 2001
5. Time of Incident: 8:52 A.M.
6. Location of Incident (Be specific): Intersection of Loras Blvd. (14th St.) and Bluff 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.)
City Bus Driver was: Melvin T. Schumacher
(See attached sheet for description of accident)
8. What were weather conditions like? Sunny
9. Give name and address of any witnesses: Tina Knockel, 1390 W. Third St., Dubuque, IA 52001
10. Did police investigate? (If so, give names of officers.) Yes, Thomas J. Schneichel SR (Badge #37)
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.)
My insurance agent (State Farm - Bob Brown) has faxed copies of 2 repair estimates which defines damages to the front end of my care, and parts required
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?
$1,937.38
16. Why do you claim the City of Dubuque is responsible?
The Bus Driver was charged with running a red light. From an insurnace stand point, isn't the city of Dubuque responsible?
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 27th day of September, 2001. , 20 .
/s/ George L. Rieder
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
aSaP,2'7. 2001T 3:43PM:~:~BARRY A LINDAHL, ESQj~s. ~,.~.-~
This written report =onatitute~ your ;loire against the City of Dubuque, Iowa, You ehould
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. 13m St., Dubuque, IA 52001,
It will then be referred by the City Council to the appropriate department for investigation,
0nee that investigation ts 0ompleted, s report and recommendation will be submitted to the
City Council. You will be provided with a copy of that rel~ort all¢l recommendation.
"" ';'~ ':"/,~"
THE FJI~L I)ECISJON ON ALL CLAIM8 IS MADE BY THE CITY COUNCIL, HO EMPLOYEE
OF T.~ cm~ OF OUSUOUE .^S T.E AUTHO.~ TO M^KE ANY .e..eSa.TA~ON TO
YOU AS TO w.~r.~. Your CLAIM WLL o. WILL NOT ~
t. Name of Claimant: ~~
3. Telephone Number:,
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full ~etalle upon which you base your claim. It a City employee was Involved, give the
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8. What were weather conditions like?
GIve nameand eddreea of anywltnessea:_ -T~_L~JA
10. Did police investigate? _Jif so, give names of officers.).
11. Was anyone injured? (If so~ give names, addresses, and extent of injuries),
~8ep.27. 2001m 3:&SPM=~BARRY A LINDAHL, ESQ,~. ~¢0.~$94__P. 2/2
..~A~
What other de.gem do you ola~, If any?
compan Ifso ' - --y ~ ~r ali of your claim by an j
Y? ( , give name and addre*~ of I,-- .......... Y nsurance
_ NJ 0 . .,o..,~-,u. soml~my anti amount Paid,)
iS. What amount do y~u alalm from the C ' - '
~ofDubuqua? · t~.~ '
16. Why do you claim the City of Dubuque ts reeponsible-~ ....... -'" --
17. Have you made any claim ilgalnst ahyone else for '
(If~ give name and address.) damages as a result bf this Incident?
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18. if the answer to Quesffol~ t? L~' yes, F/ave Yore'received any payment lmm that source,
and if sO, In what amoun~
Dated at Dubuque, Iowa this _~-,'7'rH day of_ .'~-~=~-.. ' i~.. ~p_.J 20 ~..~L. '*
(Pr Name)
(Rev. 1100 & 7/01)
O~.h ~id 9~d~S I0