Claim Henrichs, Merrill P.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: Merrill P.Henrichs
2. Address: 725 Meeker St. Galena, IL 61036
3. Telephone Number: 815 777 9335
4. Date of Incident: 1-7-05
5. Time of Incident: 2:40 P.M.
6. Location of Incident (Be specific):
Intersection of Loras Blvd. & Locust 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.)
I was stopped at the stoplight, at the intersectin of Locust St. and Loras Blvd. going north. When the light turned green,I proceeded through the intersection.
When I was approximately halfway through the intersection I noticed a vehicle approaching my side of the car.
WhenI did, Itried to accelerate to avoid a collision, but was unsuccessful. The other vehicle
hit my car in the drivers side rear portion. I then proceeding through the intersection and pulled into the first
available space, on the left side of the street. The vehicle that hit me pulled up behind me. I noticed the
vehicle was marked as a City of Dubuque vehicle from the parking dept. Two females exited the
vehicle and asked if I was alright. One of them said they would contact the police, which she did. The first
police vehicle arrived with about 5 minutes and a second one just a few minutes after that. One police officer
stayed to gather information and the other officer left. I was on my way to a basketball game at Senior, to officiate.
The officer said he would take my information and the other driver and would come to Senior to return my license and
registration. I left at that point to get to Senior. The officer returned my items around the end of the first quarter
of the game and informed that the other driver had been ticket for running the red light.
The female driver of the other vehicle was Colleen Sue Williams.
8. What were weather conditions like? Cloudy with light wet snow/rain mix.
9. Give name and address of any witnesses: There were several other cars in the area but none stopped. There
were no pedestrians in the area.
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Ted McCliman 61B
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, my 1992 Honda Accord sustained dame to the drivers side' rear bumper. The bumper was dented and had paint
scraped off.
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? Amount of lowest estimate $402.00
16. Why do you claim the City of Dubuque is responsible? The City employee ran a red light and
was ticketed by the Dubuque City Police Dept.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) No
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 1st day of April, 2005.
/s/ Merrill P. Henrichs
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
~ Mar. 24. 2005 11 :45AM CITY OF DBQ LEGAL DEPT No.3147 P. 3/4
'. ~:<
CLAIM AGAINST THE CITY OF DUBUQUE, lOW A ;J, i /f '
This written report constitutes your claim against the City of Dubuque, Iowa. You .=0
complete this form In tull'and attach sny addltlonsllnformatlon that 8Upp0rt8 your claim.
, ~
The Claim muet be flied with the City Clerk at City Hall, 50 W. 13'" St., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for Investigation.
Once that investigation II completed, a repe>>rt and recommendation will be 8ubmitted to the
City Council. You will be provided with a copy 01 that report and recomme,ndatiQn. '
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL NO EMPLOYEE
OF THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO
YOU AS TO WHETJiER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: AA e t fl' IJ ' f. f/ e n n' (;; A -s
2. Address: 72~ A/I e e k. er 5J. Cqlen~J 51. t/03t
3. Telephone Number: '?/~ ~ 77/--- 933};"
4. Date' of Incident: / - '7", () 5
2:tO, 1: #1.
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$. Time of Incident:
6. Locetlon of Incident (Be specific):
Locv~-+ .s~rcc+
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (G'tve
full ,-11s upon' which you, baSe your cl8lm~ If a City employee wae Involved; give the
emmoyee'. nam,.). ' ,
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9. Give hlme.nd .ddress of any wItnesses: 7"A eye; tv ere. . S Ev-teu;.1 crl-Acr
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10. \qJd police Inveltlgate? (If so, give names of officers.)
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11. Was anyone InJured? (If 80. give name" addresses, and extent of InJuries).
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Mar. 24. 2005 11 :45AM CITY OF DBQ LEGAL DEPT
No,3147 p, 4/4
12. W~s any damage do'ne to property? (If so, describe property and the extent of damages.
Attach estlmat.. of damages or describe basis for ascertaining extent of darnege.)
je..s, My /772- tJO~jC4 Arc 1:).1:(1 ~\dQ;1\ eel daMo~t!:. rtD
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13. What other damage. do 'you cllllm, If any? .JlOll e.
, 4. Have you been compen8ated tOr any part or an of your claim ,by any Insurance
company? (n ao, give name and address of Insurance company and amount paid.)
I/D
15. WtHIt amount do you claim from the City of Dubuque? Am ~~-+ 0..( IOi.ve-..t-+.
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eYf} Wlatf e. YOl.OO
16. Why do you claim the City of Dubuque I. ruponslb'e? ,,^e c ,,1.Y emf /D)~e e-
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17. Have you made any claim against anyone else for damag. as a result of this Incident?
(" yea, give name and addrese.) IV 0 ," '
18. If the answer to Question 17 i. ye., hive you received eny payment from that source,
and If so, in'what amount?
Dated at DUbuque. Iowa this fA
(. ~)
" .
day of A~.,)' /
-,
. 200~ .
: '
b/ 7 ~LJ
(Signature)
#~rY'l'I) f/.. !k/Jfic: J j
(Print Neme)
1..,
\"
(Rev. 1/00 & 7/01)