Claim Heiderscheit, PatrickCLAIM 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: Patrick Heiderscheit
2. Address: 758 Highland Ct. Holy Cross, IA 52052
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3. Telephone Number: (563) 870 4625
4. Date of Incident: 11-24-03
5. Time of Incident: 7:58 a.m.
6. Location of Incident (Be specific): 8th Street ParkingRamp. Top Level Northside. Corner of
8th and Iowa - 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.)
Julie Heiderscheit, my wife, slipped and fell on the ice. This is a claim
for spousalconsortium loss. The City failed to keep the ramp clear of
ice.
8. What were weather conditions like? cold
9. Give name and address of any witnesses: Kitty George, Chris Lambert, Kate Hefel, Rami Roher, and Linda Brant (all work
for Cottingham and Butler, 300 Security Bldg., Dubuque, IA )
10. Did police investigate? (If so, give names of officers.) Yes Officer Edward Baker
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Julie Heiderscheit, 758 Highland Ct. Holy Cross, IA; broken fibula at ankle and broke ankle in two places. Patric
Heiderscheit, same address - loss of spousal consortium due to wife's
injuries
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.)
Julie Heiderscheit's glasses were scratched and her pants had to be cut off.
13. What other damages do you claim, if any?
Lost wages
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?
$20,000 ata
16. Why do you claim the City of Dubuque is responsible?
Failure to maintain safe parking ramp and keep free from ice.
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 19th day of May, 2004. , 20 .
/s/ Patrick J. Heiderscheit
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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CLAIM AGAINST THE CITY OF DUBUQUE;IOW~ ' 7I!s1l//¡;
This written report constitutes your claim against the City of Dubuque, I~ 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: V~ìC'~k J!Pi\Jp'f~heì+
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3. Telephone Number: (513) 8+0 - blL¡
//-:11-/-03
4. Date of Incident:
5. Time of Incident:
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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
em 0 ~e's. a, e.)
8. What were weather conditions like?
9. Give name and address of any witnesses:
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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 damages.
Attach estimates of damages or describe basis for ascertaining extent of damage.)
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13. What other damages do you claim, if any? L@ ~J(l(fS
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.)
J1Jo
15. What amount do you claim from the City of Dubuque?
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16. Why do you claim the City of Dubuque is responsible? ç; '\ \ ÎÁçe' .-\;-0
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) 11)0
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
¡q+h day of
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q1r/cl: J fir-I'd r'í S(~(I 1-
(Print Na'me) I
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(Rev. 1/00 & 7/01)
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