Claim Thunderbirds, Dbq. HockeyCLAIM 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: Dubuque Thunderbirds dba DBQ Hockey Inc
2. Address: Five Flags Civic Center
3. Telephone Number: 557 1228
4. Date of Incident: Week of 11-5
5. Time of Incident:
6. Location of Incident (Be specific): Locked storage area inside Five Flags
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.)
Controls,Motor and other parts for Blimp flown at Hockey Games were stolen the week the Circus was in the building - Blimp basically destroyed Game jersey and Products stolen. Total $705.00
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Yes 11-12
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?
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? $705.00
16. Why do you claim the City of Dubuque is responsible?
Parts were locked inside a proper storage inside Five Flags
17. Have you made any claim against anyone else for damages 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 what amount?
Dated at Dubuque, Iowa this 26th day of Nov. , 2001.
/s/ TedScherr
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
LAIM AGAINST THE CITY OF DUBUQUE, IOWA~.D~
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. NameofClaimant:'~~"~.~-~E=~0-OC, --~ ~-~6,,~
2. Address:
3. Telephone Number:
4. Date of Incident: ~O6~% oJE- \\- $
5. Time of Incident:
6. Location of Incident (Be specific):
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
employee'sfUll~~=- ~details upOnname.)Which.~.~ ~-o ~_.,- you base~,, .~y°ur°'~-~-claim' ~}~ ~. \ c~' If a~City employee~.e~_ ~ [-~ '~'~3was involved,~c ,~=,~give the
8. What were weather conditions
9. Give name and address of any witnesses:
10. Did police investigate? (If so, 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 dame~ges~
Attach estimates of damages or describe basis for ascertaining extent of damage.)
13. What other damages do you claim, if any?.
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?
16. Why do you claim the City of Dubuque is responsible?
17. Have you made any claim against anyone else for damages 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 what amount?
Dated at Dubuque, Iowa this ~1~, day of 1~oO,0 , 20 O I '
(Signature)
(Print Name)
(Rev; 1/00 & 7/01)
BREAKDOWN OF MISSING EQUIPMENT
1. Blimp controls,motor, and other parts-blimp basically destroyed
cost to repair- ....
2. I (only) game jersey goal cut
3. Products missing
3 replica jerseys--S45.00@
4 white sweatshirts--$25.00@
cost to replace----
$135,00
$100.00
cost to replace----
$350.00
$130,00
$235.00
Total $705.00