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Claim by John HefelTHE CITY OF DUB E Masterpiece on the Mississippi BARRY LINDAHL CITY ATTORNEY MEMORANDUM ~ ~~° To: Mayor Roy D. Buol and Members of the City Council DATE: January 11, 2008 RE: Claim Against the City of Dubuque by John Hefel Claimant Date of Claim Date of Loss Nature of Claim John Hefel 01/08/08 12/28/07 Vehicle Damage This is a claim in which the claimant alleges that a City bus struck his vehicle while it was parked at 2600 Dodge Street. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. BAL:tIs cc: Michael C. Van Milligen, City Manager Jeanne Schneider, City Clerk Jon Rodocker John Hefel OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.org Claim Form Page 1. of 2 ~~ ~ ~ ~~ ~ ~~~- CLAIM AGAINST THE CITY OF DUBUQUE, IOWA r" This written report constitutes your daim against the City of Dubuque, Iowa. You should complete this form in full and attach any additional information that supports your claim. The daim must be filed with the City Clerk at City Hall, 50 West 13~' St., Dubuque, IA 52001. It will then be referred to the appropriate department for investigation and to the City Attorney's Office. Once that investigation is completed, a report and recommendation will be submitted to the City Coundl. You will be provided with a copy of that report and recommendation. The final decision on all daims is made by the City Coundl. No employee of the City of Dubuque has the authority to make any representation toy y)ou as to whether your daim will or will not be paid. 1. Name of Claimantry: ~ah~ T7~~`~-' 2. Address: `~ L~~~.v v'~ ~~ I~~rt 3. Telephone Number: ~ s) ~y.~_a S ~~ ~ ~" 4. Date of Inddent: _ /_ L ~ z ~ 5. Time of Inddent: ~ ~ l 7 `;r Vin" 7 6. Location of Inddent (fie spedfic): 1"~ ~C. ~~. ~~ ~-~~ dZ'~ ~1v~.~ ,f/~ > > 7. Describe the accident or occurrence that caused injury or damage. (Give full details upon which you base your daim. If a City employee was involved, give the employee's name.) /~- ~.; c., k, ~ y ,~~/' r<-~.c~ l~e_ l~ , c,1 e. ~ S , ,~t cam. ~ , 8. What were weather conditions like? " ~ ~ v~r -~ ~ ' ~ t(JL~~ `~VLGvI; ~ J ~u- 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) ' C~vc~ l~c~. '7F s ~~><J ;mss .~~ .~-~ s `,~, .~, 11. Was anyone injured? (If so, give names, addresses, and extent of injuries.) ~) c;~ ~4nu~) Lee ~~ 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.) 13. What other damages do you daim, if any? ~ Uti'`L-- http://www.cityofdubuque.org/printer_friendly.cfrn?pageid=155 1/2/2008 Claim Form 14. Have you been compensated for any part or all of your daim by any insurance company? (If so, give na rme and address of insurance company and amount paid.) I ~! P~/~~'fZ.~ 15. What amount do you daim from the City of Dubuque? ~ rf, y ~ h . /[? 16. Why do you daim the City of Dubuque is responsible? ~ ~~ ~ ~~~ S S~ ~ L~ U~, '7- Page 2 of 2 17. Have you made any daim against anyone else for damages as a result of this incident? (If yes, give name and address.) ~! 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? Dated this day of , 20 ig-n(a't'ure) ~ ' (Print Name) print this page ~ `C ~ T ~;~ ~ M~1 f.. Cis VJ -f, ,~ .~~ ~~ ~ j° i ~ ^T*_ ^ + ` V I l / cn - http://vvww.cityofdubuque.org/print~r ~ ,@~i~~'~r~~~,~ 1/2/2008 ~3~~~~r• 6n~~~~~tion ~~c~ange R~~ort Gub~:~~ue ?~hce Dep~rtrne:lt 563-5$ra-441Q ~ i:Jriva~rs tiarne -Last --~- r';rst - _ j ;.AiddYe j Suffix rrJ?to or l3i~i`9 U QI.IGH _~..-. ~_ _1 aT'E4"EN `~.._ _~ Ei31MARD~- ~ 01f30l19A~4_-M `---- ,- -_---E staid Z+ ~ Address ~ ~r1 P 2237 vuASHln~ _ Uarrdc.~ 7~i e1TON &Tf2EET ~ Dt3BiJOl1E ~ IA 42001 r's;t.;conse Numbat ~ Class Site Enr:orseme;?t. Resfr,c{rons I'nsuran~e Co Name T ~ Male 8002.2~41T B IA ~ P B ROWfl GC7iJtMiJA01Tll's __ _ _ _~-_._-~i_.W__ -___._..l_~._.~.t ~f)'o1 ~C?vvnsrCar~parr/ Nadna ~-~~--~-- ~ ~n.surar.ce ~clrryi{ ' CI"rY aaF DU8t1~~JE KE1f L6NE TRANSIT Phora ~ (363 384.1624' x Irlsr+rence : c ??acne tt r--_-~~ i First ; Niied'e i Sufiix Gvmer'k~ blame Las# A.ddres~ ' SOW 13TtS SY ViN No, 'Year tdake ' T7W603A~33 1978 I Gl<IIC r_.~.____ .~.__"__~._...~._.J~_.~_~.. i ~k:arse F~l.i+E ~ Sta{e Year ~, 64486 to tv t)U8l1QUE _ ._. ~ Made! ~' I.2TS R^osr Ctan~aged Area 01 -Front -___-.~ Sate Zip ~f.A 42001 . i 5tyk: i Jsmcle C.ontiyttr;,t :,.: ~b~Y L ' 18 ___~-,-_._------ _...._ . __ .__..,...__ ~ Apprr~x mate Co»i tc Repair rn Repl.~. - 5300,00 -~`~-"~_--~_----r First ~ tv4iddle I Suftia Dato of Binh Name -last! ~ ~ r ~ ~------_.~_,___._~.~.---._.. ~ ;Address ._ ~..---... -----_..._ - ---~---- - ~..~_-_ ----- --- --- - - I- - --- - i C ty ' 7tate Zip ~ -- -- --- Phone _. A _ - - 1-.._..___ __._T ._ _-----.. __~_ . _ ' ~ rwendsr Driver ~ rcensa Numosr Class-~Slata ~Enrcrsemerts ~ Rastrt;.tionsTln~warahce Co iJame TY ERS CAStiAt ' ~ ' --- - insurance Co ~~,on? ti (8631483-88E1 x i T I . tM , NtDNE ! NONC FAt 00:~ ~" ._.~'- ~_. ._.__.._..-..__ '""'~"~ Insurance Policy tK $.•rnsr Ccmnary t~art~ 'i11R3t;294$42 c,vanat's PJame - lar~t ~ ¢irsi ~ tvtiddle i Suf(ix ffEFFL _ _- --__....~ _..__._.. _..__.. _. JGHN DAVIF~ ~ _ _,------ --- i..---.. ------- ~ V i TSfate TZip _.__..--- _ _ . _ ~ 740rWAl.NUT RI GE POY>,STA iA 142088- - _ _,_----- _...~ I ViN Ne~~ r----~__..._ i Tear ARaka Modoi ~S~yls Veh~c e r .~n.,y;t rat. ~ 1GK[1T13S2424 2082 2004 ~ GNiG'. ENV S`-M __ L04 -. --_- _-._..-._.~._._~_. Y_..._...-_..___ __.~ 1 ~ --_-__ ' ; l icenae Plate ~ T ~_- ,_.-_..,. ... i elate i Yea: ! ~9ost Garnaged Area Apprrxi mate Gos? ?e Repair or Reptzce - 780Pb:?E ~ IA 2408 04 -Real' 5800 00 - _ _ - -- _=_~_ _ rCour.i4A -___' -_ ----_4ccide~r occr,rred cvithrn corporate' n^i+s of (rdy) ' , Dut~uque • 31 ---.._..~ ; ®ut~uque - 2100 -1----------- -- - - - _ _ -- -- ----. _.._ ..--------_ __-- __._. _.__---- -- ----- -- -- -- - - ~.____...- ' Lltar2l ~.')escr.phcn PARI{iNt~ LO'f EN FR~"3WT AF FRA1AlE OF h~tND _ ---- - - I X-Ccordlnat+~ ~ ~' ~oo;dir;ata Jl -^~ _ T t cc;dent cx,~urred outside of ri?y urr>tis sha renerrrl ~ acuity D;~ectkr• N;;aee,s Ciiy _ "PJ,A" 6 "PatA'" ~r I "PJfA ' Rou?e (Cardirai) I ,Travel D~rect;on EB A9 Intersection yrith ;1n Roed, $trerat, a tl,uhvyaY ~ De3RGE i ""NiA" ~ ..----- ------- .j+rac t o^ ' ^r,trrns ' . _ ~ M, ost ~,iu.~ruer Jrsts+ncr, C rec;tior j Iap i i ~ 240 Ft I S•S A anc NrA.. N:.A°'.~_ ._. of '_~~~~ __.~_ C ---- -------------- -- N CefinabMe inicrs.act~c.n brd to or raiircad crossing ~ aPresr-'-" kladye !+!c j Law Enforcement Caro lVurnber Date of Acc'dsr,t 007 ~ i Tlr e o! A c dont i 13 17 r DEUTSCti, $1367CiE 12!26!2 34 ~ 07.67663 s e7`+.•6~3; _e9;13 _7.. ~=i: !~6358'Z~12~3 •:I:!~~~:T.1SCy"J ^'iCi";-C1R L3to~~3[1~~;~E. I~~ 50~:~~ PNC7DIE: ;565; 5$r°-5~~11. F,~Y: 5~~i 5'8~-41,29 (.I~ L~tG i~?J ;381U--~ DaTE G3./0:~!'OS . ,~IOP: RyrCFrARiaSC~N MCT+~RS r'~bDR«.SS; i475 JU.HhT F. 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PXfv rM=~'XCd R~M,AN/R.~$JIL7' IT~E'ARTI;fiL REPAIR $R=~BLEt~G I~FxN1~I~ S3~Si.J$I,EI' P=~~iiECK CT,P~U;.rTRELF~'TED FRIdR 7"i+1G-STAGE -~ ~:~TERIO~i SUR,~ACES 'FWC~-STAGE' -- ~hTTERIt~ft ;sUR~'?~rE S 4 ~-W;~rEWI, GYC;Tt~E CPrUISF COr1'?' , RC `rI, E'RAME Mb '1NT'E'D ".CRAI.LER HxTC,H , CP GDF:, M~.: 3ESCRIPTTrJN NFC. E'AE?ri Nd. F'1~I~:E T1a7'v E~~ Ht~uRS Ei E 6565 E3LTMPER, REAR 15C)'~4;34'~a^Ut~~'~Ax;T 430.82 _..__ -~- ._~~~4 E :?57a COVED,1.2EA;2 F3rJMPER 123;570? GM PP.RT ~3~;.05 D 5 I~ C6~;75 1;3 C(7'JER, REA? ~UMC~ER REFIt~IZS:H . E l)5 5T. P~,1J, REAR '3U.f9PE!? ST~;p w2.3.~5704 GM PAZ1T 56. C~ ~ 8 :LR7G 4 1 Sl3 Mob Ht~ZARb. 3~3TE'. REM. Sl1k3T,li;,T REF'AI'~, 6.00* ~* S$ ALSGNN'ENT St38LLT Rk:PA;LP~ f4, . gg* 2* 6 ITEMS f3C MESSAGE (S ) ~:':. ?:t;i ~'C1'.w~~ 11: ~ :~~:,::,-;8'~ :7.~y iCiCF1~~h~:~(.~r; s,.f~~~'T J~~~u. 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Urive'7r:tin: 4 $?, T.rtj (; CY! ~t'4i757 T..i-,,, 'I"ntr}~ Y.,a`tor Linn li:can It:nrn ~ IJazaeb„r 7[",ylsr_ ` f}pvratiort 1?Cfi e :iyti~en r i~l~ixz~ sin r r.>sndov~~.~a~,AC~ ~ ~ _ R.FAIt r~Y.rna~z(i~ z~eACr E~4R _"" d o111•(s.~r .~CF; At~IGN F~EA~:3UBPENntoN a n71 sa~1 ' rvlrl-,: AY. tt3N AY?~ Tv ATari3sT TRi73JT fll7;ip1;IJBI9?hi •Ai .t. A4"T l;1 ' 73f1Y OYERZlA[I7. CCEAR'~T1'~VLP'Llt COYER ABBY °, t in10`~t~ BUY C#rMdVT3li'sT'PI.~.CR ItEARl3i57uf'*'t+:Q.;,OVER fi AL'Ttl '~.F;F' REFtNl9FT raF.1'O~t B[.T:t~ER CdYER ' a~1`)~;~, lint' REIN.UVIttFtFi.'Z,ACE iLLAtt G'TR ~G'T~l'P~;.B t3TEF RAD t; ~,C.!'t'r'l ItIlP` AUD'L ~',;l>I't CLEAR WC1A'T ~ A~r='r~ n~~azrL Cc1s'r i~a~zkrr~T~;.~rnars 17 ncJTt+ A.T}l74, L"(i9T T.•[Ala4Xtiit?t1;5 ~11rAB CF 17T3F'09Ai. * - rduc'gme731, rt,ern # • I.abur Nrtp A pplie~ (:` • Iltr'ltld~d i.n l~'Ir,ar Cco.~* f;~lc Add9 Labor 9uhitt T. In9t3fir S1r~ciLnL.g4~ t.7l73t51 h'.nkr, Aatount .M.M U~arR ~f,°.pt,~et st~~i~/ 1.tk J2.00 (~.~ _..0.~1C} Y Bw BQ T Ite+n~r3~ 8.6 a2.>.YC7 U,00 (1.U0 , Iaz.2o ar~CCi7teC,il:.wi 1.9 62.117 U..+lf! O.Ufl ? 1'7.}$91 T ~`:tzahln t,.ta4ux R4i1i.80 [„ab•+rTea tl 7,OAt~ ";, °7.90 Labe+. Sxwztnary '? 8 . •t.F;.Gt3 Park Typo/ 7.Yeii, r !,altar P~r,9:Oiuzalrer Amouet. C1a1bR 1GOAd349 dA{ FA7i,°T 43C1.1i3 0.6 ±d a.s 1,1 1.E 1.:i13ri7919 CM:~A7iT 49P,.U5 INC G 2.G 12s967ari 1Tv1 ~'AFd'3` 5G.D2 .T,'NC, l.o 1.I1,S0 R_S!1 Ci. ynrt Rvplawemra.e :ililThsess• Taxalrlo Darts Total RCAi-xctaau6 I?rr±s Azntrvpat LS7'2's~~;7'P ItISC'!.'x%,f Iv"[T$: ULClt3720t1A 7A:g0:gr1 471'3 ~Jix,c}nei[ =i,trra Vvrsiaut; [J1kts~l~3ete it+ a 1.'t.~ric~nsrl: of MSlnc~lt Ir;~ornvtinn:tl T,1FFC_t171A. Cepyriui.. (G') i9fi4 • ~:OiM ,.MttioEtirll Jnto*iwtiaaal fiilralvlxte Vrtrsion: 6.t1.02S nia Fii,rhts RFarrvcd a~9L'!tt 92l.9lA 7.fltEl1`e 6rt,6Fj 993T.4~ 7'a~~c 1 0( 2 ~)~! _ ~, .: E:~<_'~'~~ ., t h._. 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