Claim, Duehr, Jason MichaelCLAIM 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: Jason Michael Duehr
2. Address: 213 E. 22nd St. DBQ IA
3. Telephone Number: 563 582 8746 Home 563 599 6745 cell
4. Date of Incident: 5/23/02
5. Time of Incident: 8:24 a.m.
6. Location of Incident (Be specific): E. 22nd St. & Washington St.
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.)
At the said date and time Mr. Judie J. Stork was driving City vehicle #64427 and was turning right from E 22nd St. onto Washington St. at that time my vehicle was parked on E. 22nd St. legally at that time my truck was struck and
drug onto the curb.
8. What were weather conditions like?
Mid 50's to low 60's partly cloudy
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Ehlers Bade #22
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.)
Yes, my vehicle was damaged. The estimate I received stated that cost of repairs exceeds vehicles value.
13. What other damages do you claim, if any?
Towing and storage of vehicle $60 + $12 per day, also $15 for not having a vehicle.
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?
$3,600.00
16. Why do you claim the City of Dubuque is responsible?
My vehicle was parked legally and was not occupied at the time of the incident.
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 10th day of June, 2002. , 20 .
/s/ Jason Duehr
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
This written repo consfizutes your claim against the uity 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.
3. Telephone Number: ~
4. Date of Incident:
5. Time of Incident: ~-~ '~-'/"/
6. Location of Incident (Be specific)J--'~'~-
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.) ~[..~ _/_~ ,~/'J ~g'~'~. ~yl~ ~'~ ~P. ~ ~ ~
8. What were weather conditions like? m;J ~.f 4o ~ ~') patti), t/~ud}~
~. Give name and addre~ of any witnesee~:
10. Did police investigate? (!f so, give na~mes of officers.)
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.)
13. What other damages do you claim, if any? %~"~
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~ ~6 c~ ~. oo
16. Why do you claim the City of Dubuque is responsible?
17. Have you made any claim 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 at Dubuque, Iowa this
dayof --'W~q e-
_, 200~-.
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
Form 433003
PLEASE TYPE OR PRINT
~lowa Department of Transportation
INVESTIGATING OFFICER'S REPORT
OF MOTOR VEHICLE ACCIDENT
miles 0 0 0 0 O 0 0 O ofnearestcib/
=eot Miles ~ NE -~ SE S S~A W NW Feet Wiles N NE E SE S SW W NW
or O O O O'O O O O aha or O O O O O O O O of
Legal Pdvale
ntervention? [] Property? []
Y-Coordinate
0 0 0 0
~oo~, i ~ ,. None 3. Ur,.e 0. V,tr~ou~T~st R~u0~ J Dr.g1.None 3. Urine =os. N~g
Test Given? 2. Blood 4. Breath 9. Refused Tes~ Given~ [ I 2. Blood 9. Refdsed O
O O AlCOhOl I I 1.None 3. Udne 5. Vit~eousTestResults
II Mo~tOamaged j j Damage
Year Emergency Emergency
I I I I-U ~,~d? L_
Initial TravelJ veMo,~ JSpeed Po,hr el
Direction ~ ~o. I I I Limit I I I l.,,,al,~o~ot I .
I Drug 1.None 3. Urine =os. Nog
__ Test Given? bi 2. Blood 9 Refused O O
Oily State Zip
Tow # approx ma~ Cost
Repafr or Replace
I I Oondi,on~ o,.o..~dl I I Or'ver(ug,o~o II III
JS DOT# or MCf¢ I Number
O O
f Proper~ other that I Objecl
cenl¢~es aamagea expla 1 Damaged
State Year Emergency Emergency
I"'aoa'", ,., ,_u I;,:= ........
Owner's Full Name
Last, First Middle,
Street or
RFD
I Was owner or 1 - Yes 9 - Unknowr
tenant noth~ed? 2 - No
ACCIDENT ENVIRONMENT
Location of First Harm~l Event [~J Weather Conditions I II
M ...... f Crash/CclUsio. bi Iii
Mght Conditions II Surface Conditions [~
I &ciZ~: 8C~°tde~
ROADWAY CHARACTERISTICS WORK ZONE RELATED?
Major Contributing Circumstances: O Yes O No
Envlro~menl ~ J J Location
Roadway . J [J Type
Type of Roadway Junction/Feature i [~ Workers Present?
Jnlt 1 Und 2 SEQUENCE OFEVENT~
l I I ill F,TS, Event
I I II I I ~ou~,E~e.,
I I II I I Mo,iHa~mfulEvent
I I J First Harmful Event of Crash
(use codes 11-42 only)
Date: 6/6/02 09:40 AM
Estimate ID: 2091
Estimate Version: 0
Pmliminary
Profile ID: Mitchell
Schell Industries
1000 Pat St NE Box 606 Cascade, IA 92033
(563) 852-3221
Fax: (963) 852-7724
Fed ID # 42-1235100
Damage Assessed By: Randy Schell
Deductible: UNKNOWN
Owner Jason Duehr
Address: Dubuque, IA 52004
Description: 1988 Ford Pickup F150
Body Style: 2D Pkup 8' Bed 133"WB
VIN: IFTEF1484JPB74284
Options: 4WD ORAWD
Mitchell Service: 914614
Line Entry Labor Line Item
Item Number Type Operation Description
Drive Train: 8.0L lnj 8 Cyl 4WD
Part Type/ Dollar Labor
Part Number Amount Units
xceed
. a or Subtotals Ueiits Rate Amount.ubet Amo[unt
Labor Sunanary 0.0
Totals
0.00
II. Part Replacemer~ Summary
Total Replacement Parts Amount
IlL Additional Costs
Total Additional Costs
Amount
0.00
IV. Adjustments
Customer Responsibility
I. Total Labor:
Il. Total Replacement Parts:
10. Total Additional Costs:
ESTIMATE RECALL NUMBER: 6/6/02 09:35:37 2091
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: Copyright (C) 1994 - 2000 Mitchell International
UltraMate Version: 4.7.007 All Rights Reserved
Gross Total:
Amount
0,00
Amount
0.00
0.00
0.00
0.00
0.00
Page I of 2
McCANN'S IOCO TOWING SERVICE
690 W. Locust St.
DUBUQUE, IOWA 52001
Phone 563-557-8383
2~..~......~_~..~.,..:~ ~', ~
NAME ...................................................... ~'~~~ ...........................................................
MILEAGE SERVICE TIME EXTRA PERSON
FINISH FINISH FINISH
START~ ,~ START START
TOTAL ,...,c~-~- TOTAL TOTAL
SPECIAL EQUIPMENT
~ SLIN~HOIST TOW ~ F~T TIRE ~ SINGLE LINE WINCHING
~WHEEL LI~ ~ OUt OF GAS ~ DUAL LINE WINCHING
~ F~T BED/~Mp ~REOK ~ SNATCH BLOCKS
~ SCOTCH BLOCKS
~ START ~ RECOVERY ~ DOLLY
~ .ock our ~ ~
/~.~ STORAGE CHARGE ~O
TOTAL
38801
Road Service
PRODUCT613 F