Claim Hendricks, RonaldCLAIM 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: Ronald Hendricks
2. Address: 3255 Cider Ridge
`
3. Telephone Number: 588 4580
4. Date of Incident: 11 16 04
5. Time of Incident: 6:34 A.M.
6. Location of Incident (Be specific): 14th & Central Intersection
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.)
On Duty Police Officer Joseph Messerich drove through a red light at intersection
and collided with car driven by me.
8. What were weather conditions like? Good
9. Give name and address of any witnesses: Paul Breitbach, 15th & Elm St.
10. Did police investigate? (If so, give names of officers.) Officer J. Reimer
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, damage was to right front bumper - fender - door, tire and rim.
City of Dubuque Insurance adjustor should look at car - car is not driveable
13. What other damages do you claim, if any?
My car was towed to Wenzel Towing Lot - City of Dubuque should pay for this also.
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?
I will wait to talk to City of Dubuque Ins. Adjustor.
16. Why do you claim the City of Dubuque is responsible?
Officer Messerich admitted to me that he failed to stop for red light - he was charged.
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 18th day of November, 2004.
/s/ Ronald Hendricks
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
(jf, ¡ ~ I'll ¡
CLAIM AGAINST THE CITY OF DUBUQUE,"IOWA . ~~:~ j) 1fl
This wdheo 'epod coosUlutes you, claim again" the City of Dubuque, Iowa. &':~. 0
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: Z AI dL IJ lie- AI ð 12-, c-K. S
2. Address:
3;?[,~ C ¡OêtL etoCr-c:..
)
3. Telephone Number: ~ ð' -- l.f sfo
4. Date of Incident: II - / &r- t> Ý
5. Time of Incident: t: 3 i 4rvI
6. Location of Incident (Be specific):
/ if-n-J
of- C. t: AI r æ.4-L
.ÞN7?:;'7L <;c7J7ox/
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.)
tflJ tw-r'( p.,ttC-.L ðPr/c-£lt- ,T¿fJ<;<!,1/d f/Yl§""E/!/"-d ,ó/2Pý~ 7#fldl{<!rlJ 4- ~t.7J 4"'?;r
,
Jlr 1¡Jí7?)t S(£<-77/J¡vI IhJtJ cP/(¡I.)t.i:"'L:} W/77<1 .. C-4¡t!. 1>/2/ lit' A..I /fï Þ>-7¿.
8. What were weather conditions like?
Gè¿)tJ
9. Give name and address of any witnesses: p¡:¡l({. !11lé/17:14e-4
¡ ç-~IJ +- El-J'>7 57-
10. Did police investigate? (If so, give names of officers.)
I7FFICGlL .:T. RG7;1ftF/L
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.
II.ttach estimates of damages or describe basis for ascertaining extent of damage.)' .
Ye 5 - D 4-vH "'h::.-<.- W Ik 'ÍP
1í ¡z.¿ v- ¡2¡ W1
CrT'-{ tJf'- lJ"£¿,,,~ fV"ff¡t4-.</¿..'<" J'7-vflfs/V~ )/!P¡..4J /",,/( /J-r C17z... - C'~/5'
#tJr -.1)/4//( /hß ~
13. What other damages do you claim, if any? -- lI1y t:-fhl w~ '7"P w= "'W WéAJztE ¿
--r;.W¡Nr L,?-r - Cn>;, "po L>...b"1u< -5'mt.-Ú:> p~ h?K- 7lH5 11£-5'0 .
/2/&-Hr ~#-".vr &"~Ø¿k -)=£7c/,oÐ<- -Dæ>A:..
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.)
N¿J
15. What amount do you claim from the City of Dubuque? f ÞVI// t4lhr 7V 77'1z-,iC TZJ
C¡rycJÞ- J~¡"l lAC- :ÞV5, HoWf?'?£>"-
16. Why do you claim the City of Dubuque is responsible? ð~ct!':"'-- mtE551!:.~"-/~ -4o-/7/'¡::?;:J
--f?) f,1« ~ Ik r¡f,¿¿-£117> ?7lIj? ¡:;x. 1&:72 L.t6-?<lr ~ /k w4->
C ~&<' £)
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, mname and address.)
.
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
IX-
day of
¡1/ 0 if ŒWt t1 tßt..
,20~.
- .
0)
~~
(Signature)
~ .Jilt.. D fie¡.¡ 0 It- f c.-J:;: 5'
(Print Name)
(Rev. 1/00 & 7/01)
D4-r<- ¿J~ /JcC/ðê;?</T
/1~/'~L7Y
Police officer cited
A Dubuque police officer wàs
blamed for causing a two-ve-
hicle collision after he drove
through a red light at an inter-
I section in downtown Dubuque
1 Thesday, according to a pollee
report. Nobody was Injured.
I Officer Joseph Messerlch, 22,
. was cited for a red-light viola-
tion. Police said Messerlch
, failed to stop for a red light at
the intersection of 14th Street
and Central Avenue. The squad
car collided with a vehicle I
driven by Ronald L. Hendricks,
50, of 3255 Cider Ridge, who was
traveling west on 14th Street.
...-