Claim Marcotte, MaryCLAIM 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: Mary Marcotte
2. Address: 663 Jefferson
3. Telephone Number: (563) 588 0982
4. Date of Incident: 6 5 03 stolen
6 7 03 recovered
5. Time of Incident: Recovered towed 12:00 P.M. 6 7 03
6. Location of Incident (Be specific):
Burden Ave. & Hogreve
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.)
Reported my car stolen 6 5 03, Sat. 6 7 0; Got message that car was found and towed to Wenzels Towing. I was not called to come for the car. I did not authorize a tow...car was criveable when found.
8. What were weather conditions like? Clear and sunny
9. Give name and address of any witnesses: Officer Bob
10. Did police investigate? (If so, give names of officers.)
I don't know it was less than two days and they had it towed
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.)
No, car was in same condition before stolen
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? $249.10
16. Why do you claim the City of Dubuque is responsible?
Because your city employee's did not follow correct procedures.
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 July, 2003. .
/s/ Mary C. Marcotte
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
'~ ; CLAIM AGAINST THE CITY OF DUBUQUE~-.IOWA ~D~~,
This written report constitutes your claim against the City of Dubuque, Iowa. Y 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: /A .4 ,~ '/ ,~A .~/~ c o ?-2-6
Address:
3. Telephone Number:('..-~'~/-~ -(-,~P'~P' - O ~ ~ ~2.
4. Dateoflncident: <~--.5' ~ O3 ./-?-oL~..x ~ ~- ~- <2..?
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: oF~-/ ~ ~ ~-~ ~-~ R
10. Did police investigate? (if so, give names 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 dama'ges.
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? ..~ ~,~ ~,~. / Q
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)
WENZEL TOWING, INC.
24-Hour Towing Service
275 Safina St. Dubuque, IA 52003
563-556-6480 Fax 563-556-3015
M~sterCard & Visa Accepted
Service
FINISH FINISH
START ~ START ~
TOTA~ ' UATE ~. TAL
REASON FOR TOW SPECIAL EQUIPMENT
~ ACCIDENT ~ ABANDONED ~ FLAT TIRE ~ SINGLE LINE WINCHING
~ ARREST ~STOLEN CAR ~ OUT OF GAS ~ DUAL LINE WINCHING
~ UNREGISTERED ~ BREAK DOWN ~ IMPOUNDED ~ SNATCH BLOCKS
~ TOW ZONE ~ LOCK OUT ~ ~ SCOTCH BLOCKS
~ SNOW REMOVAL ~ START ~ ~ DOLLY
~PE OF TOW TOWED PER ORDER OF VEHICLE TOWED TO
~ SLING/HOIST TOW ~ STATE POLICE FIRST TOW
~ F~T BED/RAMP ~OCAL POLICE ~( ~
~WHEEL LI~ ~ OWNER
SECOND
TOW
~ ~ DEALER
TO DAYS O S MILEAGE CHARGE
I
PAID BY
E~RA PERSON I
DRIVERS
~ CASH ~ CHECK uc. NO. SPECIAL
EQUIPMENT I
EXP.
LABO~ OHA~E I
SUB-TOTAL
TAX
i Not responsible for loss or damage to vehicle Thank You
in case of fire, theft or any other cause beyond our control.
~ To Reorder: 1-800-225-6380 or www, nebs.com PRODUCT 2525