Claim Baumhover, Damian D.CLAIM 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: Damian D. Baumnhover (Property Owner)
2. Address: 2615 Dodge St. Dubuque IA 52003
3. Telephone Number: (563) 582 1856 (858) 829 1767 Cell
4. Date of Incident: 9/13/02
5. Time of Incident: 6:11 P.M.
6. Location of Incident (Be specific): 1590 University Ave. Dubuque Iowa 52001
Rear Entry of Property
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.)
See Dubuque Police Case # 02-42677
8. What were weather conditions like?
Unknown
9. Give name and address of any witnesses:
See Officers below, tenants, Larry Day, Julie Day & their children
10. Did police investigate? (If so, give names of officers.)
Nate Tayler #3162 (Co. of) BGN G.Young, Kevin Klein, Travis Kramer, Jason Pace, Karen smith, Melissa Welp
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.)
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?
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 day of , 20 .
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM 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: Damian D. Baumhover (Property Owner)
2. Address: 2615 Dodge St
3. Telephone Number: 563 582 1856 (858) 829 1767 Cell
4. Date of Incident: 9/13/02
5. Time of Incident: 6:11 P.M.
6. Location of Incident (Be specific): 1590 University Ave. Dubuque, Iowa 52001
Rear entry of property.
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.)
See Dubuque Police Case # 02-42677
8. What were weather conditions like?
Unknown
9. Give name and address of any witnesses:
See Officers below, tenants, Larry Day, Julie Day & their children
10. Did police investigate? (If so, give names of officers.)
Kevin Klein, Travis Kramer, Jason Pace, Karen Smith, Nate Tayler, Ben G. Young, Melissa Welp #3162 (co.of)
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 Officer Ben G. Young attempted to gain access to the Residence to have an arrest and damaged the rear door - see estimate.
13. What other damages do you claim, if any?
No other damages at this time.
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.)
Yes, $307.74 for door and $64.95 for lock
15. What amount do you claim from the City of Dubuque?
$892.90 minus 372.69 = $520.21
16. Why do you claim the City of Dubuque is responsible?
Police kicked door in damaging it beyond repair, including lock.
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 3 day of December, 2002. , 20 .
/s/ Damien D. Baumhover
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CiTY OF DUBUQUEc. IOWA
This written report constitutes your claim against the City of Dubuque, Iowa; You shodl~
complete this _form in full and attach any additional information that supports your claim.
The C~im must be flied with the City Clerk at City Hall, SOW, 13th St., Dubuque, IA 52001,
It wilt then be referred by the City Council to th~_ appropriate department for investigation.
Once that investigation is completed, a report a~d 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.
2. Address: " -
4. Date of ncident:
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6. Locatlonoflncident(Bespectftc):. /~ L/~JtVE~tzSiT~! ~'~. l~'Yl~3L/E~, ld~g~. 52~t
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?
9. Givenameandaddressofanywitnesses: ~C=,~ d~Ft~,'t~ (~'t~4~.J~j T'~.~ ,
10. Did police invesbgate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Attach estimates of damages or describe basis for ascertaining extent of damage.)
13. What qther damages do you claim, if any? ~30 (DTYI'~ [~'Pl.~ ~ ~.~<~ ~/x~-~.
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.)
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 incldent?
(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
(Rev, 1/00 & 7/01)
day of
(Signature)
(Print Name)
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Ve hereby submit specifications and est[mates ton ...........
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to furnish material and labor-- complete in accordance with the above spectfic~Jons for the sum of:
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