Claim Kowalske, Donald BrookeCLAIM 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: Donald Kowalskie (owner); Brook Kowalske (driver)
2. Address: 1840 Auburn St., Dubuque, IA 52001-5862
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3. Telephone Number: (563) 582 5770
4. Date of Incident: 04/19/04
5. Time of Incident: 4:15 PM
6. Location of Incident (Be specific):
Intersection of Kaufmann Ave & Grandview Ave. Dubuque, IA
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.)
A police car, driven by Officer Ted Krapfl, failed to yield from a stop sign and it struck my vehicle.
8. What were weather conditions like?
Partly cloudy; no precipitation and the pavement was dry.
9. Give name and address of any witnesses:
3rd Party Witness: George Andersen, 918 Garfield/Dubuque, IA 52001 (563) 583 2403
10. Did police investigate? (If so, give names of officers.)
Yes. Officer Kramer (Badge #40) assigned the accident case #04-16734
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Yes, Brook Kowalske, 1840 Auburn St., Dubuque, IA 52001 General discomfort
Natasha Eagleson, 1865 Atlantic St., Dubuque, IA 52001 General discomfort
Iris Wegmann, 6942 Hwy 52/ Bellevue, IA 52031 General Discomfort
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.)
Besides the damage to the vehicle, a cell phon e belonging to Brooke Kowalske was destroyed in the collission. Attached is a copy of a $208.54 estimate on the cell phone.
13. What other damages do you claim, if any?
In addition to the loss of property and hospital/doctor bills, the need for a rental vehicle should be addressed along with possible intangible damages.
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?
Open at t his stage until the cost of repair (or the value) of the vehicle can be determined.
16. Why do you claim the City of Dubuque is responsible?
Officer Krapfl was cited for FTYROW from a stop sign; his negligent driving was the cause of the accident.
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 20th day of April, 2004.
/s/ Donald L. Kowalske
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
Apr.20, 2004 !1:33AM BARRY A LINDAHL, ESQ No,4282 P.3/4
. ~. . V, fYJ.
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA &. ~ t .
This written report constitutes your claim against the City of Dubuque, Iowa. Øol7.hoUId 11
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: , Donald Kowalske (owner): Rrooke'Kowa}"kA (drivAT')
2. Address:
1840 Auburn st
Dubuque, IA 52001-5862
3. Telephone Number: (563) 582-5770
4. Date of Incident:
04/19/04
5. Time oHncident:
4:15 pm
6. Location of Incident (Be specific):
Intersection of Kaufmann Ave & Grandview Ave
Dubuque, IA
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'. name.) ,
A police car, driven bv Officer Ted Krapf}. f"ilAd to yi~ld
from a stop sign and it struck my vehicle.
8. What were weather conditions like? Partly cloudy; no precipitation and the,
pavement was dry. ' ,
9. Give name and address of any witnesses:
3rd Party Witness: ,George Andresen 918 Garfield/Dubuque, IA 52001 (563) 583-2403
10. Did police investigate? (" so, give namès of officers.)
Yes. Officer Kramer,(Ra~¿# 40) A""i[nAd tn~ ~~~;d~nt ~~~o f 04-167~4
11. Was anyone InJured? (If so, give names, addresses, and extent of Injuries).
Yes. Brooke Kowalske 1840 Auburn st/Dubuque, IA 52001 General discomfort
Natasha Eagleson 1865 Atlantic st/Dubuque, IA 52001 General discomfort
Iris Wegmann 6942 Hwy 52/Bellevue, IA 52031 General discomfo;t
Apr,20, 2004 11:WM
BA~RY A LINDAHL, ESQ
No, 4282
P 4/4
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.)
Besides the damage to the vehicle. a eel phone belonging to RrookA KoWAl ",k~
was destroyed in the collision.
Attached is a copy of $ 208.54 estimate
on the eel phone.
13. What other damages do you claim, if any? In addition to the loss of -orO1)erty and
hospital/doctor bills, the need for a rental vehicle should be addressed along
with possible intangible damages.
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?
Open at this stage until
the cost of repair (or the value) of the vehicle can be determined.
16. Why do you claim the City of Dubuque is responsible?
Officer Krapfl was cited for
FTYROW fr~m a stop sign; his negligent driving was the cause of the accident.
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
20th
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AtJril
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(Signature)
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