Claim Frick, Thomas & MichelleCLAIM 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 P.M.
6. Location of Incident (Be specific): Corner of 18th St. & Jackson, Dubuque, IA 52001
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 Employee Wade A. Heineman pulled from a Stop Sign on 18th St. and Struck Rt Rear Wheel & Fender of Frick Vehicle
City EMployee Ticketed.
8. What were weather conditions like? Not a contributing 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 and 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 Chevy K1500, Estimate (Open End) $946.93 from Runde Chevrolet
13. What other damages do you claim, if any? (Use of a Rental Vehicle While Vehicle Being Repaired)
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 on how long it takes 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.
/s/ Thomas J. Frick
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
1~:$1 CITY OF DUB. CORM. COUNSEL 9 31955644~5
(Late Loc. Code)
CLAIM AGAINST THE CITY OF DUBUQUE
This writuen report constitutes your claim
Dubuque, Iowa. You should co~plets this foz-m in full and attach
any additional infor=,ation that supports your claim.
The Claim mus~ be filed with the city Clerk. It will then be
referred by the city Council to the appropriate Department for
investigation. Once that investigation is completea, a report and
recommendation will be Submitted to =he City Council, You will be
provided with a copy of that reporU and recommendation.
THE FINAL DECISION ON ALL CLAIMS IS ,v~DE BY THE CITY COUNCIL.
NO EMPLOYEE OF THE CITY OF DUBUQUE HAS THE A~THORITY TO MAKE ANY
REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE
PAID.
1. Name of Claimant: THO~S J FRICK & MICHELLE M FRICK
2. Address: 3220 ASBURY ~, DUBUQUE IA 52001
TelephOne N~mher:
Date of Incident:
5. Time 6f Incident:
$.
.319-557-9569
ito5/oi
3:30 P.M.
Location of incident. (Be specific) CORNER OF 18TH ST & JACKSON,
NO.040 ..... D02
DUBUQUE IOWA
7. DESCRIBE~ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE.
(Give full details upon which you base your claim. If a City
~ ~ploYee was involved, give the employee's na~ne.)
/-- ~ IGN ON 18TH STREET
,, ~ x '~, . -- LE CITY E~LOYEE TICKETED
~ A~..~f~CK RT REAR WHEEL & FE~ER OF FRICK VEHIC ·
~ ~ .... =-~--- like? NOT A CONTRIBUTING FACTOR
B.~ were weak,er con~iuxu~
Give name and address of any witnesses. N/A
10. Did police investigate? (If So, give n~mes o~ officers.)
YES, CITY OF DUBUQUE. OFFICERS KRAMER & SMITH CASE #01-693
11.
Wks anyone injured?
injuries.)
NONE
(If so, give name,
address and extent of
CITY
12. Was any damage done ~o property? (I~ so, describe proper~y
and the exten~ of damage. Attach estimates o~ damages or
describe basis for ascertaining extent of ~sm~age.)
199Y CHEVY K1500. ESTIMATE (OPEN END) $946.93 PROM RUNDE C~EVROLET
13.
What other damages do you claim, if any?
(USE OF A RENTAL VEHICLE WHILE VEHICLE BEING REPAIRED)
14.
Have you been compensated for any par~ ur a!l of your claim by
any insurance company? (If so, give-name and address of
insurance company and amount pai~.
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 ~laim the City of Dubuque zs responsible?
CITY DRIVER PULLED PROM STOP SIGN & HIT FRICK VEHICLE
17.
Have you made any claim against anyone else for damages as a
result o~ this incident? NO
If yes, give name and address:
18. If the answer to Question 17 is yes, have you receive~ any
payment from that source, and if so, in what amount?
Dated at Dubuque,
~K 2001 .
iowa, this 9TH
day of JANUARY .,
(signature.)
(Print Name)
(Revised 9/90)
09:57 FAX 1 319 583 8085 .... FLYNN PRINTING
DAMAGE ESTIMATE
CUSTOM WORK . SANDBLASTING . FRAME STRAIGHTENING
'
Authorization for Repair ,
~aTS ......................................... , 37~.YO
RUNDE CHEVROLET
Hwy. 35 No~h
East Dubuque, IL 61025 TOWING ........................................... $
74L~018 '
TaX ....................................................