Claim Huntington, RonaldCLAIM 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: Ronald Huntington
2. Address: 2510 Windsor
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3. Telephone Number: 556 5079
4. Date of Incident: 8 12 03
5. Time of Incident: Afternoon
6. Location of Incident (Be specific):
Corner of Windsor & Merz
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 Attached letter
8. What were weather conditions like?
9. Give name and address of any witnesses: N/A
10. Did police investigate? (If so, give names of officers.)
No
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.)
Brush guard on front of 1988 Toyota Pick Up was hit, broke 2 welds and pushed brush guard in on the same side
13. What other damages do you claim, if any?
None
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?
$128.40
16. Why do you claim the City of Dubuque is responsible?
See Attached letter
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 18th day of August, 2003.
/s/ Ronald Huntington
(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:
2. Address:
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
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 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 ~dar~ag~s.
Attach estimates of damages or describe basis for ascertaining extent of damage.)
J
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.)
//~/0
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is res ponsible?
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
(Signature)
(Print Name) '/
(Rev. i/00 & 7/01)
~AL'S GARAGE
1005 Century Circle
Dubuque, IA 52002
(563) 583-9202
Date_ ~"'/~'
1 'i 065
Operations and Maintenance Departiuent
925 Kerper Boulevard
Dubuque, Iowa 52001-2338
(563) 5894250 office
(563) 589-4252 fax
(563) 5894193 ~DD
ops &maint~gcityof dubuque.org
Dear SidMs:
The City of Dubuque Operations & Maintenance Department
acknowledges that we have damaged your property, building and/or
vehicle. Since the employee's supervisor has determined that the
estimated cost to repair the damage does not exceed $1,000.00, the
Police Department was not required to assist with paperwork,
investigation, etc..
Please contact the City Clerk at 589-4120 to obtain a damage claim
form.
We apologize for the damage we have caused and the
inconveniences that have resulted for you.
Sincerely,
Opera'tT6ns & Maintenance Manager
Serv4ce People Integrity Responsibility Izmovafion Teamwork