Claim Schumacher, JamesCLAIM 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: James Schumacher
2. Address: 104 Jule Ave. East Dubuque, IL 61025
3. Telephone Number: HM (815) 747 3804 Wk (563) 556 4141
4. Date of Incident: 12-01-01
5. Time of Incident: 12:49 P.M.
6. Location of Incident (Be specific): 32nd St. and Central
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.)
Schumacher (Northbound on Central) stopped @ Stop Light when Russ Bowman driving City of Dubuque Vehicle rear ended Schumacher. Bowman charged FT Maintain Control.
8. What were weather conditions like? Clear
9. Give name and address of any witnesses: None
10. Did police investigate? (If so, give names of officers.) Yes Report # 01-49956
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.)
Yager Auto $983.29
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.)
No
15. What amount do you claim from the City of Dubuque?
Damages from Claim
16. Why do you claim the City of Dubuque is responsible?
Bowman Driving City Vehicle Rearended Schumacher
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
None
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
No
Dated at Dubuque, Iowa this 10 day of December , 2001
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
Dee.lO, 2001 3:22PM BARRY A LINDAHL, ESQ No.5644 P, 1/2
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This wrltt~n report ~xmstit~tes your olaim against the City of Dubuque, Iowa, You should
complete this form in full and attach any additional Information that supports your ~laim.
The Ctaim must be filed with the City Clark at City Hall, $0 W. 13~ ~t., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for Investigation.
One. e that Investigation is completed, a report and recommendation will be submitted to the
City Ceurtall, You will be provided with a copy of that report and recommendation.
THE RNAL DECIE1ON OH ALL CLNMS tfl MADE BY THE CITY COU.ClL. ~]O EMPLOYEE
OF THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPREIIENTATION TO
YOU Ail TO WHETHER YOUR CLAIM W1LL OR WILL NOT BE PAID.
7, DESCRIBE ACCIDEN¥ OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE, (Give
full detail~ upon which you base your claim. If a City employee was Involved, give the
· Io ' 0
!
8. What .Were weather conditions like?
9. Give name and address of any witnesses:_
.Dec,lO, 2001_ 3:22PM__BARRY A LI.ND_,A_.H...L...ESQ_.~ __N0,5644 P, 2/2
Was anyone inlured? (if so, give names, addresses, end extent of injuries).
13, Wi~at ~)ther damages do you claim, if any?.
14. Have you been compensated for any part or all of your claim by any Insurance
camp;my?.. (If se, give name and address of insurance company and t~motlnt paid,)
· IS. What ..amount clo you Claim f~om the City of Dubuque?
16. Why dp you claim the City of DubUque is r~nsible?~
· 17. Ha~ ~ou ma~ any clalm agai~t anyone el~ for dama~s as a reeult of this i~oidsnt?
(If y~, gl~ name a~ add~=.) ~ ~
18. If ~e an~er ~ Qu~lon 17 ~s ye~, ~a~ y~u re=e~ed any payment from that sou~e~
and if so, in what amount?
Dated at Dubuque, Iowa thls
/,,.