Claim Repsonse - Frick, Tom & MCLAIM 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: Thomas J Frick & Michelle M Frick
2. Address: 3220 Asbury Rd, Dubuque Ia 52001
3. Telephone Number: 319-557-9569
4. Date of Incident: 1/05/01
5. Time of Incident: 3:30 PM
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.)
City Empolyee, Wand A Heineman, paulled from a stop sign on 18th street and struck rt rear wheel and fender fo frick vehicle. city employee ticketed.
8. What were weather conditions like? not a contribuiting factor
9. Give name and address of any witnesses: n/a
10. Did police investigate? (If so, give names of officers.) yes, city of dubuque. Officers kramer & smith case #01-693
11. Was anyone injured? (If so, give names, addresses, and extent of injuries). none
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.)1997 chev k1500 open end $946.93 from runde chevrolet
13. What other damages do you claim, if any? use of rental vehicle while vehicle being repaird
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? $946.93 plus ( est is an open end estimate on the rear axle)
also rental car but depends how long it will take for repairs.
16. Why do you claim the City of Dubuque is responsible? City driver pulled from stop sign & hit frick vehicle
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 9th day of January , 2001 .
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
BARRY A.. LINDAHL, E
CoKPOKATiOIq COUlq SE J~
MEMO
To:
Mayor Terrance M. Duggan
and members of the City Council
~anuary 25, 2001
Claim o~ Thomas J. & Michelle M. Frick
Claimant
Date of Claim Date of Loss Nature of Claim
Thomas & Michelle Frick 1/11/01
12/29/00 vehicle damage
This is a claim for damages the claimants' car sustained when
it was struck by a city vehicle that pulled out from a stop sign on
18th and Jackson Streets.
This claim has been referred to Public Entity Risk Services of
Iowa, the agent for the Iowa Communities Assurance P0ol.
BAL/cg
cc - Mr. David Harris
Housing Services Manager
cc - Mr. and Mrs. Thomas J. Frick
¢- radii b~lcscl~rnwci.~et