Claim Ricke, Darryl T.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: Darryl T. Ricke
2. Address: 16110 Oak Bluffs Ct., East Dubuque, IL 61025
`
3. Telephone Number: 815 747 2948
4. Date of Incident: 01/27/2005
5. Time of Incident: 1345
6. Location of Incident (Be specific): E. 17th & Jackson St.
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.)
Heading S. on Jackson, was going to turn on W 16th Street while driving past 17th St.
I saw the truck at Stop Sign, so while driving past 17 Street looking forward, that's when
he hit my front end of my truck (David Peter Haupert) off Duty Officer. He called the accident in.
8. What were weather conditions like? Sunny, Pavement dry.
9. Give name and address of any witnesses: Michael Ricke, Jerod Freese, Alex Chorak, Tyler Vandsnider, Students of Nativity BVM School, E. D. IL
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Ehler
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, Right Front Corner Panel; Right Front Wheel Hub;
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?
$1,348.25
16. Why do you claim the City of Dubuque is responsible?
Because it was a Police Officer hired by the City of Dubuque that hit my truck.
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 11 day of February, 2005. , 20 .
/s/ Darryl T. Ricke
Darryl Ricke
(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 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:
OAP.RYL /. K/r2.f\E.
2. Address: /6//0 OAk 8L UFf5 c.T. C175r PI/oc'auE IL 61r72)~
3. Telephone Number: 8Jf. 1(1.('7. ). 918
4. Date of Incident: 0 I /:z 7 I;). 0 0 :J
5. Time of Incident: / 3 I( 5-
6. Location of Incident (Be specific):
E, t'l7H fJACf:.So)J STReff
.
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.)
HEACI/I/<:!! S, OIJ J!tC-f<.50;), (,VIIS GOI/vb 70 rVIi# all W /~ 5T/?,EET
j
tu/fIi.E DRlv/PC PM! 1'7 ff{ I SAW THE rf<UCk Al 'Jlo!' 5tGP, so VJHILe PRIIIING
fA>? II] 51flf-E-r [.00/\ IIVG FORwIrRfJ, -rH/tf5 VJHIEP HE HIT/Y7Y r/?/J//7 F~O d~/J1>' rfi'tJcf(
(O/J V ro PElf R, H AU PE RI J oFF Wry OFFICF- RJ HE. eAU E lJ THE A a. IPF-/.IT I /V.
8. What were weather conditions like? S () JCJ j,/ Y., P/11/ f !'II E. PT 0 R Y
9. Give name and address of any witnesses: fY!ICH.1E L RI vAt) J fl? 00 F/?EEse,
AL.EX c.HORIiK) TYl..[f\uJANVy,IJIHR.} STuIJE,JIT5 of'/V4TfIlITi f3v,M 5CHoOL,c /JIL.
10. Did police investigate? (If so, give names of officers.)
Yf- 5, OFFicER EHLER.
,
11. Was anyone injured? (If so, give name~, 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.)
F {ION T BUM fER A tG I-IT FROP, CORP If? PAfiI ~ 1- J {<" G Hi fRo)./7
J -
(JJHHL /-Iuf3
13. What other damages do you claim, if any? )J a jJ f
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? ,f~ 3'1 't. :l )'
16. Why do you claim the City of Dubuque is responsible? 8 E C Ii u 5' E (T rJJ A S A-
PO((CE OFF/GER I-II(1EO 13 Y THE CITY OF Ov!3UQuC THAI !-lIT
/I1Y T /?(J ell
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? IV 0
Dated at Dubuque, Iowa this
II
day of
Fc8 {JIM Y
.
, 20 &1'>.
J)rM/I:? 7 fd<.k
~ (Signature)
i/A/f!?(C. l1/c/(E
:J (Print Name)
. ._, _.." I ~
\
_:(.1
(Rev. 1/00 & 7/01)
Form 433003
01.01
MAIL REPORTS 1'0:
low. o.p,rtment of Transportation
Office of Driver Services
Perk Falf Mall, 100 Euclid Avenue
P.O. Box 9204
Des Moines, Iowa 50306.9204
~ Iowa Department of Transportation
.'" INVESTIGATING OFFICER'S REPORT
OF MOTOR VEHICLE ACCIDENT
Accident occurred within DI.I I ,A uf t?
cor ratellmllsof cl ...,,0"'1 vlt::'
Sheet of
Lo~,:"mr;i?:b
Legm Private
Intervention? 0 Property?
o
If <<ccIden\ ".a outsIde of W NW
cIty IImlls show general vicinity miles 0 0 0 0 0 0 0 0 of nearest city
On Road. Slreal. "'T",. L' A\lntersecllon ~ /7 fb
or HI hway: V ",-C 70t) with: ~ I
Note: Unless eccldent occurred at an Intersection which Is completely deilcribed above, use the space belOW to give the SJQl;cllocation from a milepost
or deflMble Intersection, bliOge, or railroad croBslng, using two distances and directions If necessary.
Feel Miles N NE E SE S SW W NW Feet Miles N NE E SE S SW W NW
0' OOOOOOOO.nd 0' OOOOOOOOof
County:_Route:_
X-Coordinate:
Y.Coordl"~",' I
If Dlvlded. HigtlW3y, Provide Route
(Cardinal) Jravel Dlrectlon
NB'SB EB WB
000 0
Cltstlon
Cherge
,:;'
2,
Alcohol I 1. None 3. Urine 5, Vitreous Test Ru\Jlt1!,:
Test GIVen? L!.J 2. Blood 4. Breath 9. Refused
Address'
" .. ~-, .
4.
Drug I 1. None 3. Urine
Test Given? ~ 2. Blood 9. Refused
Pas. Nag.
,,-CI~/
V'<C4 PH f
~\~. 2Y~A/PP
::rlt
Zip
>~Ol
Y1!J .,
_"""to
RlIp.llrorRtp~
$2;~
Tow 0
Private?
o
d
U
N
I
T
2
AlIachedto
PowerUnll:
State Year
CI~
US DOT. or MC#
o 0
If Property other than Object
vehicles damaged explaIn Damaged
Owner's Full Name
(LBst,FlrsI.Middlel
Slreetor
RFD
ACCIDENT ENVIRONMENT
Placard # I
IU HSlBrdousMsterialSU
- Released?
Unit' Unit 2 SEQUENCE OFEVENT
Environment
U
LU
WORK ZONE RELATED?
DYes ONo
U Locallon
UType
LU LU First Event
LU LU Second Event
L..L..J LU Third Event
L..L..J LU Foorlh Event
Location of First Harmful Event U Weather Condillons L...LJ
(up to two)
Clly,State,
& ZIp Code
ROADWAY CHARACTERISTICS
Major Contrlbutlng Circumstances:
Marmer of CrashlCo\\\5\on
u
U Surface Conditions
LU
U
Roadway
LU LU Most Harmful Event
{by vehicle)
UghtCondltlons
Type ()f Roadway JunctionlFealure LU
U Workers Present?
LU
First Harmful Event of Crash
(use codes 11-42 only)
nHi,.,"',....r."...,.."."
(: ~ \ fi'l,
n.,rlnn "I"
'-., -'..
/
Damage Assessed By: Randy Beadle
Deductible: 0.00
Claim Number: NA
Kieffer Body Shop
20100 us 20 WEST EAST DUBUQUE, IL 61026
(816) 747-3044
Fax: (816) 747-3044
Tax ID: 38-3028967
Owner DARRYL RICKE
Address: 16110 OAK BLUFF COURT EAST DUBUQUE, IL 61026
Telephone: Home Phone: (816) 747-2948
Mitchell Service: 916489
Date:
Estimate 10:
Estimate Version:
Preliminary
ProfilelD:
Description: 1998 Chevrolet Pickup K1600
Body Style: 2D PkupXCb 8' Bed 166" WB Drive Train: 6.7L Inj 8 Cyl4WD
VIN: 2GCEK19R2Wl163726
Options: 4WD OR AWD, ALUM/ALLOY WHEELS, AIR CONDITIONING, POWER WINDOWS, POWER DOOR LOCKS
CRUISE CONTROL, AUTOMATIC TRANSMISSION, AM-FM STEREO/CDPLAYER(SINGLE)
Line Entry LallOr
Item Number Type
1 646607 lUlY
2 600940 BDY
3 546452 BDY
4 612370 BDY
6 AUTO REF
6 612800 BOY
7 614740 BOY
8 900600 MCH"
8 AUTO REF
10 933006 BDY
11 833018 REF
12 AUTO
13 AUTO
Operation
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/lNSTALL
REPAIR
REFINISH
REMOVEIINSTALL
REMOVE/REPLACE
ALIGN
ADD'L OPR
ADD'L OPR
AOO'L OPR
ADD'L COST
ADD'L COST
Line hem
Description
FRT BUMPER FACE BAR
FRT BUMPER IMPACT STRIP
R FENDER WHEEL OPENING MLDG
R FENDER PANEL
R FENDER OUTSIDE
R LWR FENDER ADHESIVE MOULDING
WHEEL
FRONT END ALIGN
CLEAR COAT
RESTORE CORROSION PROTECTION
MASK FOR OVERSPRAY
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
. - Judgement Item
# - Labor Note Applies
C - Included In Clear Coat Calc
ESTIMATE RECALL NUMBER: 2/31200616:22:19 2173
UttraMate is a Trademark of MitchelllnternatlonaJ
Mitchell Data Version: JAN_06_A Copyright IC) 1994 - 2003 Mitchell International
Ultra Mate Version: 6.0.031 An Rights Reserved
Part Type!
Part Number
16674112 GM PART
ORDER FROM DEALER
Existing
Existing
12360632 GM PART
Sublet
2/3/200503:25 PM
2173
o
Mitchell
Dollar
Amount
220.80
41.40
620.16
0,00 ..
6.00.
6.00 .
100.80'
4.00 ..
Labor
Units
1.4 #
INC #
0.2
1.0'#
C 2.8
0.2.
0.3
1.9"
1.0.
Page 1 of 2
~
Date:
EslimalelD:
Estimate Version:
Preliminary
ProfilelD:
2/3/200603:26 PM
2173
o
Milchell
I. Labor Subtotals
Body
Refinish
Mechanical
Units
3.1
3.6
1.9
Rate
45.00
45.00
53.00
Add'I
Labor
Amount
5.00
5.00
0.00
Sublet
Amount
0.00
0.00
0.00
Totals
144.50
167.00
100.70
II. Part Replacement Summary
Taxable Parts
Sales Tax
@
6.260%
Amount
782.36
48.80
Total Replacement Parts Amount
831.25
Non-Taxable labor
412.20
labor Summary
8.6
412.20
m. Additional Costs Amount IV. Adjustments Amount
Nonw Taxable Costs 104.80 Insurance Deductible 0.00
Total Additional Costs 104.80 Customer Responsibility 0.00
I. Total Labor: 412.20
II. Total Replacement Parts: 831.26
m. Total AddKlonal Costs: 10UO
Gross Total: 1,348.26
IV. Total Adjustments: 0.00
Net Total: 1,348.26
This is a preliminary estimate.
Additional chanaes to the estimate maY be reauired for the actual repair.
ESTIMATE RECAI.L NUMBER: 2/31200616:22:19 2173
UttraMate is . Trademark of Mitchelllnl.rnalloRal
Mllchell Oala Version: JAN 06 A Copyrlghl (CI 1994 _ 2003 M/lchelllnlem8llonal
UltraMate Version: 6.0.031 - All Rights Reserved
Page 2 of 2