Claim Hefel, DaleCLAIM 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: Dale Hefel
2. Address: 905 Nevada St.
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3. Telephone Number: 563 556 5751
4. Date of Incident: May 13, 2004
5. Time of Incident: 7:00 A.M.
6. Location of Incident (Be specific):
Garbage cans by front curb had lid ropes cut and thrown away,
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.)
Garbage collectors cut and threw away ropes connecting lids to garbage cans.
Garbage collectors cut & threw away ropes connecting lids to garbage cans.
8. What were weather conditions like? Clear
9. Give name and address of any witnesses:
Unk
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.)
Yes ropes were cut and thrown away - I want the cost of ropes & time spent to install them.
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?
$7.50
16. Why do you claim the City of Dubuque is responsible?
The ropes were cut & thrown away by City employees. There is no role in City garbage guide about this.
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 27th day of May, 2004. .
/s/ Dale Hefel
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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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 additi(mal 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~ILL ~R WILL NOT BE PAID.
1. Name of Claimant: ~c.l
2. Address:~\~~r:-- Sf
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7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
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4. Date of Incident:
5. Time of Incident:
8. What were weather conditions like? . (11~
9. Give name and address of any witnesses:~~
10. ~~Olice investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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? ~,}\N;V
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.)
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15. What amount do you claim from the City of Dubuque? ~ '11-SD
16. Why do you claim the City of Dubuque is responSible?~ J \k"\~ L1CC\;.~
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, givè"ìïame and address.) ~ Q)
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
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(Rev. 1/00 & 7/01)
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Dated at Dubuque, Iowa this