Claim by Thomas HamelTHE CTI'Y OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL ~~ I~
CITY ATTORNEY '1~`
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
January 21, 2009
Claim Against the City of Dubuque by the Thomas Hamel
Date of Claim
Thomas Hamel
01 /15/09
Date of Loss
01 /04/09
Nature of Claim
Property Damage
This is a claim in which claimant alleges that a City snowplow truck was unable to stop
due to icy conditions and struck claimant's brick and stone mailbox.
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
John Klostermann, Street & Sewer Maintenance Supervisor
Thomas Hamel
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
C,~,~ ~ ~
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. You sh Id
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 C
2. Address:
3. Telephone Number: L~~ ~ '' y ~~(~ r-- ~ ~ ~ ~
4. Date of Incident: ..,/ p! ~~ ~~ ~ ~ G'
5. Time of Incident: ~' ~ 3 G ~}
6. Location of Incident (Be specific):
7. DESCRIBE ACCIDENT
full details upon which y
employee's name.)
OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
~u base your claim. If a City employee was involved, give the
What were weather conditions
Give name and address of any witnesses:
11. Was anyone injured? (If s/o/,give names, addresses, and extent of injuries).
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10. Did police investigate? (If so, give names of officers.)
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?
~Q, U
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 ~~of Dubuque j5 regponsibl
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17. Have you made'any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) ,~ f~
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 ~ day of '~V lz~tiuc ~, 20 ~%9
Signature)
l ~ (5 /1'!~} ~ ~~ -~~}"!'~1 E ~ (Print Name)
(Rev. 1 /00 & 7101)
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