Claim Hoerner Schainker, JaniceJames J. Roth*
Francis Wm. Henkels
Benjamin J. Roth
ROTH & HENKELS
400 UNIVERSITY AVENUE, SUITE D
DUBUQUE, Ia 52001-593 !
Telephone: (563) 557-1611
Facsimile: (563) 557-9775
E-mail: BRoth@RothAnd He nke ls.com
January 8, 2003
Jeanne Schneider, CitY Clerk
City Hail - CitY Clerk's Office
50 West 13th Street
Dubuque, IA 52001
Our Client:
Date of Injury:
Property:
Janice $chainker n/k/a Janice Hoerner
02/02/01
2711 Jackson Street
Dubuque, IA 52001
Dear Ms. Schneider:
Enclosed please find the claim form regarding the above-mentioned case.
As you know the statute of limitations on this matter is coming up, any effort on your part
to expedite the claims-handling would be appreciated.
Please contact me should you have any questions.
Sincerely,
Benjamin J. Roth
B JR
Enclosure
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.
3. Telephone Number:
4. Date of lncident: ~-/az.
5. Time of Incident: /~7~'==. ~ ?,~
6. Location of Incident (Be specific):
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. Give name and address of any witnesses:
10. Did police inv~e~tigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).