Claim Bovee, ArleneCLAIM 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: Arlene Bovee
2. Address: 1005 Levon Ct.
`
3. Telephone Number: 563 582 2917
4. Date of Incident: 6 9 04
5. Time of Incident: 12:05 P.M.
6. Location of Incident (Be specific):
2700 Block of Hillcrest Rd.
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.)
Our car was stopped behind the garbage truck waiting for the driver, David Castro, to pull up, or if remaining stopped, for an oncoming vehicle to come by, before passing. The truck
coasted back - no warning sounds or lock-up lights, apparently to retrieve garbage two lots behind and side-swiped
our vehicle.
8. What were weather conditions like? Normal
9. Give name and address of any witnesses: My husband, George Graves, and I of 1005 Levon Ct., Dubuque IA 52003 and the truck driver, David Castro, 1455 S. Grandview, Dubuque, IA 52003
10. Did police investigate? (If so, give names of officers.) Yes, Koch, (45A)
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.)
Front bumper of our car was scratched. Right side rear view mirror was demolished.
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.)
State Farm, P.O. Box 83106, Lincoln, NE, has promised to pay $420.30 to ABRA Auto Body & Glass pending outcome of this claim.
15. What amount do you claim from the City of Dubuque? $670.30
16. Why do you claim the City of Dubuque is responsible?
Our car was stopped, the truck rolled back into us without warning.
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 June, 20 04. .
/s/ Arlene J. Bovee
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
. ~4p~ ~¿/
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: A R L e rV IE 8 t? v4il e
2. Address: ! I? 0 5 Lev () Net
3. Telephone Number: 5 G 3 - 5" &' ;¿ - ;;:z <7 I 7
4. Date of Incident: ¡; - C> '9 ~ 0 'í
5. Time of Incident:
I ;¿ ~ 0 S p, Y)1 ,
,
0(/1, [lGRé~t R: 1.
6. Location of Incident (Be specific): ;;¿ 70 D B L /{.
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full d.etails upon Wh.iCh you base your claim'I7.)f a ~City emploY!r was involved?JI~ve the
employee's name.) É7þN1 ~ "V""-d ~ ~ ~ ~ ~ ~ 5-
7f;k~" ) £r~';'¡¿ ~A<">.;i;¿ ~ -uf" 1M Þ{ ~~ AA"~Ç!. r ~
~~ t;;;:~ d~74~ ~ ~, ~
~£l ~~~ -.v>. "'^-'.R,:.Þ'o,
8. What were weather conditions like? N () R /')-1 Ii L
9. Give name and address of any witnesses: ~ .a......J..... - J} I l:r~a.. ~ ¡ ~ ..t
{/DO!; ~ d.ßJ~ ,1/1 S:¿OD3~:I-6 ~ Il~ :1:7~_:.£~, /'i~S
.J..!J~ ,þ'~fl s:<Do3
10. Did police investigate? (If so, give names of officers.)
ye:s J ffl7r:h ) (45A)
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.)
;;:¡, ~ ~fVU\ t{ tJ-oU/\. ~ ~ ~~ ßvz.d? i
ø
Rr~~~~if\ ~4~~,
13. What other damages do you claim, if any? N n J'-Ì €
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.)
StAte. fr,RI'Y\/POß(>¡<83IDIo,liNcoLN./V£,f?II) P~omJ$ed fõ
, ,
p",/"tf:20,30 tð ARRA Aut~ e&Jy.¡..CLAß'S p"'Ndu\i9 otttcomQ of fh/s c.LfJrir..
15. What amount do you claim from the City of Dubuque? ¡"¡;' 7 O. 3D
16. Why do you claim the City of Dubuque is responsible? if M./L C<:Vl v~ ~
.J!k. ;t;.~ ~ A.o.Jl "" ~ Æ.-<4 ~ &--u/f ~ ¡ ,
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
th.
1'1:'--- day of
J~
átI~ ß 13 rtHL
(Signa re)
/f-1L fAir -iF 130 J/ £ E
(Print Name)
. 20QÏ.
'.'
~«
(~) -.
'-'
ç
;.:¡:
""
"~1
=)
-'"
C:J
(Rev. 1/00 & 7/01)
-.~,.,..,....
---
--.",--