Claim Helling, Jeanne
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: Jeanne Helling
2. Address: 269 York, Dubuque, IA 52003
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3. Telephone Number: 563 588 0911
4. Date of Incident: 7 6 04
5. Time of Incident: 11:15 a.m.
6. Location of Incident (Be specific):
950 Main St. in front of KANNDO
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 -
8. What were weather conditions like?
ckear/sunny
9. Give name and address of any witnesses:
Sue Westhoff - employee of KANNDO
10. Did police investigate? (If so, give names of officers.)
No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
myself- Jeanne Helling
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.)
No
13. What other damages do you claim, if any?
Medical Expenses Incurred @ Medical ASsociates & Taylor Pharmacy
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.)
Medical Associates would send claim to BC/BS but I know BC/BS will send info to how this "accident" happened.
15. What amount do you claim from the City of Dubuque?
medical expenses @ Medical ASsociates & Taylor Pharmacy
16. Why do you claim the City of Dubuque is responsible?
Uneven sidewalk on City property - Residents much comply with sidewalks so City should too.
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 10 day of July, 2004.
./s/ Jeanne E. Helling
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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'. CLAIM AGAINST THE CITY OF DUBUQUE,"IOWA ~j)
This written report constitutes your claim against the City of Dubuque, Iowa. You slÍ6uld
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: S.e a /1 11 & H-e {(Ii] j-
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2. Address:
3. Telephone Number:
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4, Date of Incident: '1 - (p - 04
5. Time of Incident: II. I 5' (.1. ¡I\I\ .
6. Location of Incident (Be specific): C¡5D tvta ¡VI :S-tv-eef 11'\ -t1rcvd7 1 .(/4-NlUbD
7. DESCRIBE ACCIDENT OR OCCIIRRENCE 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.)
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8. What were weather conditions like? ~leC4- I ~)(..LfWlt
9. Give name and address of any witnesses: ~1 f-. W.et:rf--tto-fF - ~~
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10. Did police investigate? (If so, give names of officers.)
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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?~'tal ---ef-Çe )Aves I Vll"lL ~ý.e d
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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? w.Ldica.(. ~?t??
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16. Why do you claim the City of Dubuque is responsible? UAt.e ue.~ ~è!J.€ LUa.( (L-
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17. Have you made any claim against anyone else for damagi:)s as a result of this incident?
(If yes, give name and address;) f:Jö
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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Signature , ."
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(Print Name)
Dated at Dubuque, Iowa this
10
day of
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(Rev. 1/00 & 7/01)
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On July 6 at about 11: 15 a,m, my husband, Jerry Hanson, 2 children and I went to
KANNDO to get a piece of carpet cleaned, I went into KANNDO to see if we had to
bring the carpet into the front of the store or if we had to go around to the back (alley), A
woman employee ofKANNDO, Sue Westofftold me to just bring it through the front
So I went out to the van to tell my husband that the carpet had to go through the
front, ..as I was walking to the van to tell Jerry, I fell over uneven sidewalk and I had flat
sandals on, I scrapped my left knee and just above my left ankle/top of my foot area, I
also ripped the pants I was wearing around the knee, I went home immediately and
cleaned and put medicated cream on the wounds, As the day went on my left leg was in
pain along with my shoulders and wrist due to the shock of the fall because I land on my
wrists too trying to catch myself.
I have been cleaning and putting medicated cream on all week but by Friday, July 9th my
wound at the ankle area was so infected and my foot was swelling up the entire week, I
have been propping my leg/foot every night in bed trying to get the swelling down, It
would be down by morning but then swell back up during the day and even by night I
couldn't bend my toes as they were so swelling, Because my foot was so infected and the
swelling was getting worse, I went to Acute Care at Medical Associates and was given
some antibiotics to take 4xday, Dr. George Isaac was the physician, I faithfully took the
antibiotics as scheduled and by Tuesday, July 13 I was back at the same acute care as the
swelling has not gotten better. I saw Dr. Craig Schultz and he ordered an x-ray of my
foot and ankle, X-rays came back negative however Dr. Schultz said due to the swelling
it is hard to see it really clear. He wanted me to give it another week, Throughout this
entire time I could hardly walk as the infection was right where you bend your
foot, ,painful, throbbing, and swelling, Going up and down stairs was even difficult
Today is July 22 and my ankle is still tender to touch, The swelling is getting better but
still there but not as much,
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