Claim by Jim Huff0710212008 12:16
3193854709 RICHARD REALTY
CLAIM ,AGAINST 7'I~E CITY OF DU~LTQYJL, IOWA
This ari~rn rre p~ this form in fu I andlattach any ddibonal in orm tian't a a~ you
shou p
supports your claim.
The claim must be Paled v~rith the City Clerk at City Hall, 50 West 13th St.,
Dubuque, IA 5001. It wi l then be re#erred to the appropriate department for
investigation and to the ~ity Attorney's Office. Once that investigation is
completed, a report and recommendation will be submitted to the City Council.
You will be provided with~ia copy of that report and recommendation.
The final decision on all Maims 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 of will not be paid.
~{ , Name of Claimant:
~, ... _~ r
2. Address: ~ ~ ~ ~
3. Telephone Number,
4. Da#e of Incident:
5. Time of Incident: ~? . ~ ~
t;. Location of Incident (Be
7, pescribe the accident or occurrence that caused injury or damage. {Give full
details upon which you base your claim. If a City employee was involved, give
PAGE 02
8. What were weather conditions like?
9. Give nar:~e and address of eny witnesses: ~ .~ r aZ3.~
I Lei t G ~rs C.C P ~ ~ / ! ~ I-Gr ~t ~1_ i ~ ~~
:~
1Q. Did police inves#igate7 (If so, give names of afiFicers.)
c r;
~} = rv
cn .~
~~ ~
w
_ ~~
r ,%~'~%~~~~~ ~~ ~
~~
7
iT1
0710212008 12:16 3193854709 RICHARD REALTY PAGE 03
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.) _ ~~ ~ ~ ~-- _ .~.
'~
I
1~. What other damages do you claim, if any? ,
14. Mave~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.)
Q
15. What mount do you claim from the City of Dubuque?
c=
_:
e
16;Why do you claim the C~ of Dubuque is responsible?
.t n n !7 ~ .
ti -
17. Have you made any claim against anyone vise far damages as a result of
this incident? (If yes, give name and address.)
i
18. If the answer to Ques#ion 17 is yes, have you received any payment Pram that
source, and if so, in what amount?
aced is ~~ day of _ +'c~ 4r , 20 8 c~ .
_ _
( ignature)
(Print Name)
07102!2008 12:16 3193854709 RICHARD REALTY PAGE 04
J u 1, 2. 2 b 0 $~ ~ 11.5 8 AM ~„~ pvpaNr4w~~+ns o~ Trwrrsportetlon `"" k-N o. b 7 2 Q~~~F, 1
ewt a+ea law DepeArt~oN W 1Yartera~D DY~pB-7992
plNeeein,hrerBervlae ~ INYF„STK>MATING OfFIO~11S E1!?PQRT vote
a«rp.ve+.i~ taOEudldAew>~ee OF MOTOR 1f1:liIC1.~ACCIDENT ,~p1e,,,b,~ Prm.M
P.O. gg~~ 9$01
Dertyloree4loaaeaDe ~p,~L00ey,redw naelPWaMNmarai{cilY1 ~N~,10MUtiptian
pate d Tlms ~~ C0~ ue -?tQ0 01 OLp }110FiWAY RD and e
~, eliR7109 ,y~tl0 Fke, pnUergree -di ' BEIPPEL RG
' o RaealMl~oaur,edoute~tlrrdeNYllmle- ~A" ~~ww
ehew0ana'MxkM` r orreeareetonT
- C adReze. 1nnLaHiaitwyy. ~~"aer:4onv+e+'
A "N!A" eNe tha epe00 RMt"ea r pee Ere vllaal x.ceeiaateat OOi07A90
T -NOIR Unrsaeaaltlera aaeunad at an inleteodbn nlNlri ~~d~.~ IlMl19 ~~'°~ deerraee Niledre01b7te N row"enr1: Y.Oeloltl4ele: O~tl409T
~ bca0alhmlreadlepenardaNnabb;dereetlian,b,idNa~ Olrnralon
~~ aratlion plNmrtele "I1IA' oT tt DW1dwr Nlatraay PrOVltle Re:4e
• " ~OaYdYerijTraraliY,ladiele
4 „wA~~ ryA and "EUA
N nswlaor jrpenaglen, erldae, avraNroed eroeadq ~7WA"
MilaPeeeNUmra or "WA"
TUA° Rime Svll'ot *~
p~ArN•aRtF•leel Ftral TTB.4TSTX
!T GGNNDDRR ROAD J 9A GTY 5sS0T
CtialknCieMOeCedel CtrtionCharp
oaaNP gfradeleeereeeNeearar
0111i17BB1 1.29S81e91077~~e~ ReeMeltane CaurareChawCode2 CaalbnChM9e2
Male VNI d e MONN 0TH Cllepae Ctursa Code 8 Cllolien Charee 9
Taal
Akoeni Tmd av~i Teel aeavrta: GreNon Change Caen ~ CaMlon Chorea 4
,S{yer}7 TaelRelele:
t .Nero i -Hone an 1 Trgopetl i
(~ 8eatina t}eeaea0l Ii~vrYSl~+e' barapanl Praleglan9 >~4 ~Pi9Y'"°~ ~' Atrtiw 6wWCh StalUa 0 61er~on 7 T
1~1 ranrpone a: '~
M~ gip oamer omprnNeme
T j SE7eme • Lea Y °AjyNNERA 6 r~
,ciF~llP ~ 4aM6
Atleraea
' 001 621 Tllfi 67 P8 B01c Z7i ~~ ProaY s - uowRa Prue a ergo rier
thy.enoe R .Nome tA-Ppa1602 SHtgQ (A 7D69
5HEL ~ ~eR r
V!N Na Vner . AAaYa Modal ~e ~0 a Aaps~ Y~Replaca
~er~sap~0212fen J.QDS neegN - ppbQ SON lIIT SateMOf 4D lhrdwflde+ ~~
biri Travel Vd+ids 8 PoaN °~ Mow Dameged 02 D S Cvertlda 1 Q i7 000.00
D'aaat+>" 4 Aetian o1 «NN 3e hoer t Dz nro Yfl~ ~~qg c;C1A~~,
Vehkle Oerge EedY Vehier OMr+ ~
T ~ • ca~ireie ew eetna e1 Tme 01 P~ 01 cananen 1 anaoued 01 arrrert,~oarao)
SE4uteNCP~ of EVENTS Fi,el eveni A~ ssaarea Eveni Thirtl evep po,ath evert Meet Nemrd even! (rYwlticNp Zz
Comnwriiel petler Atiadrod io Iwo . Year Altadaele 91ne Yorf ~~erra~ t ata~iue~
lfaeffea PMF P Pa1Ypr N"L Treget {1MC
Addreee Cilf 81e1e XiP
Center N ems
Numrsref Cf091VOlerde Preardi~F NennlouaMMarhia
UB oOTM or MC to Axba fleli~B Releaeap7
Jt~ aorta ~ iBfl~4
orlvere N.ma. rate, M~0 ea
ca aNy c et.Le
Addroee A9T DUB M
ate o! sirrri orhrarx timnee Nameer t:eren Ohorpa Cade 1 PAIL TO OBEY S7DP SNiN
e+~zarlse2 T6iYY@8!B ~ ~zi.32z
Bleu sae Erdor+re+eeen tine aMilnnCriergaCodaJ CUrtbnchege~
as,Wer -
Atele IA a IrONE B Ceetlon Ohree Cafe 3 CNaSten chaos a
b Teel
~ t Teal Taal Results: Gh~enT Toni Reeuaa~ C110TanChalpe Cade a Cpagen CLerge d .
i-None i-None
V 9eeting Posilion01 mJu1r 5tplw 6 aeeupant Prolacaonl J4rbrg DeFieymem 5 AS,baN 9aadt 8lelus 9 H(edlat t Fission PeUI h Tnaaed t
Tla~~ Trenep
T taemera NpiHe • Al F rn rateete Surfer ~IiY F oUB~e
Ciey Stele Rip
OOR M iD~NA 6T DLJO U4UE IA t.iEenee Piano * ttutu n.
NNt.a,ae PaCQ' X101 a a zoos
p -A~COMM~A$BURANCe Tows MrewOmrieCaairo
pgypT~tyi(sKa46ae9 BOOS Paid-FbRD CROYVOI VICTORIA ~ YE6 RaP~a-Replace
Wletmval vahlde sped Pdnla( Mdet0ame0ed Pslanlor unaen+aar awrMeT ® is ooD.w
Direattdrr C Ad'dfl 01 tiling 78 ~MNnpaci 01 Are 01 4 ~~ 1
Total 1',eAie VaY,lga CarOo 9adY Vefrlcie store Canrbultne 1?uc+aaeiarsel.
accuparta i Oanoala ta4 Cerifie. 01 Type 01 Derd 01 c"MrUm 1 QyeWed Ot artalupleeeel Ot
LYgUIp1CE Of EVt?NTS Fral Evert ,BI Sxerk Evert 7iard k'eahl Fourrr C-vmd NwtFiarmtW Erenl WY~~It'~Ml ~
CemmMdelTteGlet h1IeMMdb SgtO riot plleeeraio BWe YMr VeMcletYae x ~wper~q ,
ideeraievleled P~~+"~ TtaNorUr~ ~huraa RR
CarrFn uem Address tyr stele Zip
US DO7 ri or MC Nuarberd Gtaaa YNWI9 Pbeerdrl Xeenrdorre Maladak
~} tiVNelrl ReNrrD t#raaerrM
P'rlrtted AL• Dubuque caunTy Ofirtlfl'a Olf OTAIlfz009 04;47 AlYI pogo t Fvrm 7Ik OS•0!-TYSi
07/02f2008 12:16 3193854709 RICHARD REALTY PAGE 05
,~,,,.~.~.,,.,..,,~,~..~..._.~~ ....__..~Q._...._- -__.~o. a~~a~--- ~. ~
Ju 1. 2. 2006""11; 59RM ~~-~°~'~°"
lacetion of FPS MenYW Erwx 1 ~''~°,'edu~~ ns Roedwry
MgM,grrlgyst~Gnnaen ' C1 iFTfolite~lProsr~
S~alecr Cand~lons 2 l~pa eT JIep11a+IFsetula 1
LgMCOndNnn^ a
i ~
~IPPEL` ROAD
~ ~ 1
I •Z
A
G '
R ~~ dt
p ow ~i1WAY ROAfI
M I
p!!e/ilfe Whet 11lDPl~-oa Iranrw ~e~.w.~ r^ .•_•••-~•.
UNIT 4N+= WAS MgVINO WEST ON OlD HIG1iWAY ROAD AT i'HE INTER9EC710N W1711;3E1PPEl. ROAp, UNIT TWO WAS
MOVING SOUTH ON SEIPPEL ROAD AT THE INTERSECTION WITH OI.D HIGHWAY ROAp, UNIT Tyu4 DRQVE 7HROUGH
INTERSECTION UN~TwO TF~10EN STRUCK UNIIT oNEAN THE Mi~D[N.>~ PF THE INTER~~IOM~. THROUGH THE
y! aNamu- m " RV$E
1 PAIL3ET ~~~` C! Sala Gods
T Addrrst J88UP IA 60~
E x'11 aTeYC~lS PG BOx 23a ,~ won.! .
g MI! PflorM -
- --- - eeapaNa 'IA1ne oarN~G^QdAecMenl Sllnrvma.r,umraa,uacenx
TIAI b161 24:1D _ T. nra 22:6 ~.
0!f 061Z61ZQlP moao ai ~cwrd+ Yea
Pdotld Ak BubUgY! CQY~II BAeTIR'6 OIT 071QZ12006 0,:~9 AIM Pag! 2 Fong A: 02-flB 7632
07/02/2008 12:16 3193854709 RICHARD REALTY PAGE 01
RICHARD REALTY & AUCTIaN, INC,
605 East Winfield Avenue
M7. PLEASANT, IOWA 52641
319-385-2000 or319-367-2p00
Fax: 319-385-4709
t r a n s m i t t a l
to: t r` d` ~~~~
fax: ~$~l~ D ~
from: r c..i..
date: ~, Q
re; ~ a
Y~cuc4a-~t'_
pages: