Claim Foley, RyanCLAIM 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: Ryan Foley
2. Address: 5521 Fond Du Lac Ave
3. Telephone Number: 582 2185
4. Date of Incident: Feb. 9, 2001
5. Time of Incident: 7:24
6. Location of Incident (Be specific):
Ideal Ln and Ruann
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.)
A snowplow driven by Vincent George Conner sideswiped my car when it was parked.
8. What were weather conditions like? Snow, Ice.
9. Give name and address of any witnesses: Any Daack, 1500 Ideal Ln.
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Slight
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.)
The snow plow took off my driver side mirror. It also took off the handle to my door and made several dents and scratches.
13. What other damages do you claim, if any?
None
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?
$700.00
16. Why do you claim the City of Dubuque is responsible?
Vincent George Conner is employed by the City, and was plowing the Streets for the City at the time the incident occurred.
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 17th day of February, 2001. , 20 .
/s/ Ryan Foley
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE
CITY OF DUBUQUE
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 wilt 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 TEE CITY OF DUBUQHE HAS THE AUTHORITY TO MAKE ANY
REPRESENTATION TO YOH AS TO W~ETHER YOUR CLAIM WILL OR WILL NOT BE
PAID.
1.
2.
3.
4.
5.
6.
Name of Claimant: ~, ~l&~I
Telephone Nua~ber: E~-I;~-
Time of Incident: 7':
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.)
8. What were weather conditions like? ~n~ ;" ~'d_~
9. Give n~e ~d address of a~y witnesses. ~ ~.
10. Did police investigate? (If so,
11. Was anyone injured?
injuries.)
give names of officers.)
(If so, give name, address and extent of
12. Was any damage done to property? (If so, describe property
and the extent of damage. Attach estimates of damages or
describe basis for ascertaining extent of damage.)
13. ~at ot~er d~a~es do you ~laim, if ~y?
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.
Itave you made any claim against anyone else
result of this incident?
for damages as a
If yes, give name and address:
18. If the answer to Question 17 is yes, have you received ~ny
payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa, this [~{3~_ day of ~k~U
2001. ~
Hanley Auto Body ine.
1930 Century Circle Dubuque, iA 52002
($18) S83~7220
Fax: (319) 583-8355
D~mage Assessed By: Robert Hantey
Deductible: UNKNOWN
Owner Ryan Foley
Address: 5521 Fond Du Lac
Telephone: Home Phone: (319) 582.2185
Mitchell Service: 910471
Description: 1987 Chevrolet Cavalier CS
B~ly Style: 4D Sed
Data: 2/12/01 12:52 PM
Estimate ID: 1423
0
Preliminary
Profile ID: Mitchell
Drive Train: 2.0L Inj 4 Cyl 4M
Line Entry Labor
Item Number Type Operation
I 9005OO BDY* REPAIR
* - Judgement Item
Line Item
Description
Part Typ~
Part Number
Existing
COST TO REPAIR EXCEEDS VALUE
Detler Labor
Amount UnIts
0.0'
I. Labor Subtotals Units
Labor Surm]tary 0.0
18. AddiUonet Costs
Total Additional Costs
Add'l
Labor Sublet
Rate Amount Amount
Totals II. Part Replacement Summary
0.00 Total Replacement Parts Amount
Amount IV. Adjusanouts
0.00 Customer Respons~ility
I. Total Labor:
II. Total Replacement Parts:
IlL Total Additional Costs:
Gross Total:
Total AdjuSts:
Net Total:
This is a preliminary estirna~
Additional chanqes to the estimate may be required for the actual repair.
0.00
0.00
0.00
0.00
0.00
0.00
0,00
ESTIMATE RECALL NUMBER; 2/12/01 12:51:09 1423
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