Claim Response Trice, Anthony
BARRY A. LINDAHL, Es .
CORPORATION COUNSEL, CITY OF DUBUQUE
MEMO
TO:
Mayor Roy D. Buol and
Members of the City Council
DATE:
January 5, 2006
RE:
Claim against the City of Dubuque by Anthony Trice
Claimant
Date of Claim
Date of Loss
Nature of Claim
Anthony Trice
01/05/06
01/04/06
Vehicle Damage
This is a claim in which the claimant alleges that while his vehicle was parked at 455
Almond Street, a City of Dubuque refuse truck struck claimant's vehicle.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
BAL:tls
cc: Michael C. Van Milligen, City Manager
Jeanne Schneider, City Clerk
Paul Schultz, Solid Waste Management Supervisor
Anthony Trice
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113/ FAX (563) 583-1040/ EMAIL balesq@cityofdubuque.org
. C13 G;rO\V\c\ ?('IX L2
, =t:: teVV1~S '\ e C tt/\t \ it' V\. +- i VI.- ~ J ~ ~ ~ C~ f' ,
Y - t\je. W -t', \Je S _ ____ $ ~/tJo-oo
I - Ni( 0 5 -t c~ If' t e,r- _------ --- cf ~, DO
~ - 1\)(0 t\.-1--'Z I ; Vtj-'< ctors-~--- jj _sS7) , 0 Z?
3 - tv f'0 Co \ t ' 'P 19{ G k 5 ____/--~ 41 100' D 0
) - N~vJ 1~\"\\t\(X\i'Yjoj~\~ #/).O.O()
jf 0;)L/o,oo
tV J+ ~ .'
LOI.loor No+ ~"'L\\AJe'J
/1
l-:~
90 KENNEDY ROAD
DUBUQUE, IA 52002
563-583-5781
EsnMATE OF REPAIR COSTS
NAME ~r.;th.OI"\.'-1 \12; C .<t- DATE \/'-1 <J6
YEAR q~ MILAGEJ.<::{\.<l<:O
MAKE G~~\O ~"'- ADVISOR
MODEL r'~I\t, c..r TECHNICIAN ~'Ik.SL..ft\'U--
,
I .ft DAD....,
_=n"ej)c.~ -.i..... ~ Lh I
...L" ","-" If- LlJlt L>.e.
VQ..L\.H 0... 1M '<"SO(\ '3 e-
. . ,
--""\ C\LU'~ ~I........ao
I
-'-
\~A.~~SrYY'SS,~ ~"'~I'\.< r/2~.J.. II
.JLvL.- Brot:.e
..&.Ilrler
~~ 6u......D I""-
.ll:::: cr- '5vn.-"'".r-
~--L .J L"G.\-...T
2ltUL~ ~ C' ~ 't- .... c:l" \II\..e t ~ .J..lo!..L
I\A "'"LA ~
SUBTOTAL -
TAX
TOTAL
Firm 433093
i 01.01
U
T
$E TYPE OR PRINT
Data of A dent
L.t
MAIL REPORTS TO:
Office of Orrver Services
Iowa Department of Transportation oWwa lbepartment of Transportation
P.OPark Fair Mall. ,�u Euclid Avenue �, INVESTIGATING OFFICER'S REPORT
Dee
Moines,Box a 5030S-9294 OF MOTOR VEHICLE ACCIDENT
Time of Accident
a accident occurred outside or
city limits Show genera! vicinity
On Road, Street,
or Highway.
Sheet 1 of
Law Enforcement Casa Numbers -
County
Accident occurred within
corporate limits of (oily)
miles ❑ O 0 ❑ 0 0 0 0 at nearest city
.. ' At Intersection
Not*: Unless accident occurred al an intersection which is complet dyalbed above, use the space below to give the exact location from a %%post
or definable intersection. bridge, or railroad Crossing, using two distances and dtrecuonei it necessary.
Feel Miles
Of
Milepost
Number
Legal
trdervention?
Private
Properly.?
County. Route:
XCoordInafs:
Y Coordinate:
000 000p0'
Driver's Name (Leaf. First, Middle)
Dale of Binh
Or Definable intersection,
bridge, or railroad crossing
^r 3
Drivers License Number
esnictions
Owners Name (Last, First, Middle)
and
Citation
Charge
Feet
Address
2
Miles
of
NW
0000000of
4•
Alcohol 1 None 3. Urine 5 Vitreous 'reel Ror.ulls Drug
Test Grenc u ? Blood 4 Breath 9. Refused
r )
In5Wenoe Co +7
Name ,� .:j ( )) r- T.
ViNa
Fyh
Initial Travel Vehicle Speed Point of
Dlrecrron 11 Action usJ Limit L_LJ initialImpac U_J
Total 1 Traffic ' + I Vehicle Jj
occupants i I 1 Controls I__._L_J Cenfig. %L1IT.ps o BveyLi
Correnerciel Trailer Attached to
License Plata it Power Unit
Carrier
Name
Address
If Divided Highway, Provide Route
(Cardinal) Travel Direction
NB SB EB WB
0 0 ❑ ❑
Slate Zip
%ter r t S2 r"k
Teal Given?
City
?.None 3.Udne " Neg.
2. Blood 9 Refused
State Zip
US T# or O
- ... .y t_rcense
e_ f r •., 1 Plate #
-
Maks Modef r Style
"l2 �L I L;'(0'} L
Most Damaged 1 1 Extern of Underride&J
Area 1 .1 Damage ulOverride Li
Vehicle Driver Vision
Defect I, I Jr condtion I_ ! Quschred W
State Year Attached to Stare
Trager Una
Address
7;j7==:
Tow #
City
Private?
Stele I Year
Appraxlrnale Cool in
Repairer Replace
s
Contributing (up
two) Circumstances, I ' I I J
Driver [up (p two) L�_J l._LJ
Year Emergency I Emergency
Vehicle TypeUStatue L-I
Stele Zip
II
Drivers Name (Last. First, Middle}
Number
LJ I II of Axles
Date of Binh ❑ravers License Number
Gross Vahlde
Weight Rating
Address
Placard
III I III I i erdvus Haterlois
Rateesod'7
City State Zip
u
Muio Female
0 0
Slate
Class
Owner's Name (Last, First, Middle)
!floweriest Co.
Endorsements) Rest
one
Citation
Charge '
2
3
4
Alcohol 7. None 3. Urine 5. Vitreous Test Results: Test Given? U 2. Blood 4. Breath S. Refused Drug I 7. None 3. LeineRefu Pus.
Teat Given? 2. Blond 9. Refused 0 0
IJ
r Address
Name .'.. 3 r ;
insurance
Policy #
Fear
City
State Zip
License
VIN # 1 Plate #
I . - r _ - Year Make tjci.ti...).,
odel Style
Ll _ : kid ,rradial Travel r I hiSpeed -
Direceon LJ 1 Poim of Moat Damaged Ex[errl of rOvernrida!ion LI� Limit I I 1 Inniel Impact I, ,I J I Area I 1 I
Total Trafficf J Damage LJ+ Override u
Occupants L_ __J Controls VehicleVenfg I I Cargo Bad) Vehicle I Driver
I I I 1 Type 11 J I Doled L I— f 1 condemn i I I Obscured U I f
Yawn
Commercial Trailer Aeeched to
License Plate it Power Unit:
Carrier
Name
USDOTM or MC
Insurance
Policy #
11 I 1 1 I 1 I I d! Dines
If Property other than Dbiect
vehicles damaged explain Damaged!
Owner's Fee Name
ILast. First. Middle)
State Year Attached to
Trailer unit
Address
City
Tow #
Private?
CI
Stale Year
IApnreenmapgn+nte Cost le
Repair or Replace
Contributing Cvcvrratancsa,
Driver (up to two)
L_LJ cy
Year I Emergency l IEmergency
Vehicle Typal J Status
Slate Zip
Street or
RFC'
ACCIDENT ENVIRONMENT
Location of First HdrmfuI Event U
Messner of CraehiColksion
Light Conditions
u
Gross vehids
bWnijhl Refing
II Estimate or
Damage S
IPlacard # I I I I- u
Was owner or 1 - Yes 9 - Unknown
tenant notified? U 2-Nu
Ci y. Stale.
& Zip Code
Weather Conditions l I I
fug to two)
Li Surface Conditions
LLI
u
ROADWAY CHARACTER t3TICS
Major Contributing Circumstances:
Environment
Roadway
u
Ili
Type or Roadway JunchootFeature I I I
WORK ZONE RELATED?
0 Yes ❑ No
Li Locator
u TYPs
u Workers Present?
eiereous Materiels
erceaSed?
Unit 1 Unil 2 SEQUENCE OFEVENTS
f LL' IJI Firer Event
L_ I LLJ Second Event
W LLI Third Event
Li] C� I I Fourth Event
1—LI LLj
Most Halmiul Event
(by veNcie)
J First Harmful Event of Crash
(use cedes f 1-l2 only)
Officer's Name_ • "� , ��
Sedge No, '