Claim, Tigges, Susan - RonaldCLAIM 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: Susan & Ronald Tigges
2. Address: 11374 Maple Grove Ct., Dubuque, IA 52001
3. Telephone Number: Home 583 9501 Sue Work 557 1611
4. Date of Incident: 9 21 01
5. Time of Incident: 12:28 P.M.
6. Location of Incident (Be specific):
Corner of Wood St. & University Ave. in Dubuque, IA
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.)
A bus owned by the City of Dubuque was southbound on Wood St., turning right onto University when it cut the corner too sharp and struck my parked vehicle.
8. What were weather conditions like? Clear, sunny
9. Give name and address of any witnesses:
a man that lives on the corner of Wood & University (name unknown)
10. Did police investigate? (If so, give names of officers.)
Yes, See report.
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.)
Yes, Rear Left corner of vehicle. See estimates in possession of City Attorney's office.
13. What other damages do you claim, if any?
Car rental while the vehicle is being repair, amount unkonwn.
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?
$1288 plus car rental (see par 13 above)
16. Why do you claim the City of Dubuque is responsible?
City driver struck a parked vehicle. He was charged with improper right hand turn.
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?
N/A
Dated at Dubuque, Iowa this 6th day of November , 2001. .
/s/ Sue Tigges
Susan M. Tigges
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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. 13~ 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.
1. Name of Claimant:
2. Address:
3. Telephone Number:
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.
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
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.)
8.' What were weather conditions like?
9. Give name and address of any witnesses:.
10.LI~s'Did police in~ga~ ,give names of officers.)_~
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.)
13. What other damages do you claim, if any? ~l..~..~ ~,~ ~ ~_~._~_
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.)
15. What amount do you claim from the City of Dubuque?
17. Havo ~ou mad~ an~ claim a~ain~t an~on~ ~1,~ for dama~e~
{If ~e~ namo and address.)
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 ~L~ day of
{$ignatu~)~
(Print Name)
(Rev. 1/00 & 7/01)