Claim Kramer, Gene A.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. 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: Gene A. Kramer
2. Address: 2940 Central, Dubuque, IA 52001
3. Telephone Number: 329 583 5706
4. Date of Incident: 12-30-00
5. Time of Incident:
6. Location of Incident (Be specific):
9th St. & Hwy 61-151 Ramp Intersection
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.)
My girlfriend was driving my car southbound on 61-151 Ramp and stopped at 9th ST. Stop Sign - The snow ws piled so high at the intersection that she had to pull into the intersection to see and
another car hit her.
8. What were weather conditions like? Dark - Clear
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Scott Simpson
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.)
1986 Toyota Celica - Totaled - Valued at $2100 by Du-Trac Credit Union on 1-27-01
13. What other damages do you claim, if any?
$122.96 for towing - Police said Car was not Driveable. I drove the Car home from Wenzel Towing.
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?
$2222.96
16. Why do you claim the City of Dubuque is responsible?
The City failed to maintain a safe intersection by letting snow pile up to high since this accident occured the snow has been removed. I have pictures the day after accident and
two weeks later.
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 4th day of February, 2001. , 20 .
/s/ Gene A. Kramer
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST
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
West 13th Street, Dubuque, Iowa 52001-4864. 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
REPP~S--~TATION TO YOU AS TO.WH~T~--~R ¥OUP. CL%IM WILL OR WILL HOT BE
PAID.
1. Name of Claimant: ~/~
4. Date o~ Incident~- /~-~d)-~D '
5. Time of Incident:
6.
7. ESCa E'AcC Oa OCC CE T CAUSED Oa
(~ive: full details upo=.which you base ~our cla~. If a City
~loyee was involved, give the ~ployee~s n~e.)
9. Give ~me and ad~es's of any wi~esses.
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give name, address and extent of
injuries. )
12. Was any d~ge done to property? (If so, describe property
and the extent of damage. Attach estimates of damages or
describe basks for ascertaining extent of damage.)
13. What other damages do you claim, if any?
14. Aave'?ou been compensa~e~ rot any part or all of your claxm by
any ~nsu~ance company? (If so, give ~e 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. ~V~¢OU ~e~, C~ 'gal~st anyone else for d~a~es as~
result of ~is incid~t~ ~
If yes, give name and address=
18. If the answer to Question
payment fr~m that-source,
17 .is Ye,~_~. h_a.v_~.you received any
~d if so, in what amount?
(Revised January, 2000)
this
- (~-/gnature)
( Pr ~nt -Name)