Claim Response Trice, Anthony
BARRY A. LINDAHL, Es .
CORPORATION COUNSEL, CITY OF DUBUQUE
MEMO
TO:
Mayor Roy D. Buol and
Members of the City Council
DATE:
January 5, 2006
RE:
Claim against the City of Dubuque by Anthony Trice
Claimant
Date of Claim
Date of Loss
Nature of Claim
Anthony Trice
01/05/06
01/04/06
Vehicle Damage
This is a claim in which the claimant alleges that while his vehicle was parked at 455
Almond Street, a City of Dubuque refuse truck struck claimant's vehicle.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
BAL:tls
cc: Michael C. Van Milligen, City Manager
Jeanne Schneider, City Clerk
Paul Schultz, Solid Waste Management Supervisor
Anthony Trice
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113/ FAX (563) 583-1040/ EMAIL balesq@cityofdubuque.org
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90 KENNEDY ROAD
DUBUQUE, IA 52002
563-583-5781
EsnMATE OF REPAIR COSTS
NAME ~r.;th.OI"\.'-1 \12; C .<t- DATE \/'-1 <J6
YEAR q~ MILAGEJ.<::{\.<l<:O
MAKE G~~\O ~"'- ADVISOR
MODEL r'~I\t, c..r TECHNICIAN ~'Ik.SL..ft\'U--
,
I .ft DAD....,
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SUBTOTAL -
TAX
TOTAL
F~433003
01-01
MAIL REPORTS TO:
Iowa Department of Transpottstlon
Office of Oriver Services
Park Fait Mall. 100 Euclid Avenue
P.O, Box 9204
Des Moines, Iowa 50306-9204
6~OlNa 'epartment>Of Transportation
.' INVESTIGATING OFFICER'S REPORT
OF MOTOR VEHICLE ACCIDENT
Accident occurred within
corporate limits of (cily)
7=
of nearest city '"
At Intersection
or Highway: ~,l with: '\
Note; Unless accident occurred at an intersection which is completEAY d~cribed above, 'use the sp~ce beiow to give the e:O:Bct location from alniiepost
or definable intersection, bridge, or railroad crossing, using two ditltances and directions if necessary.
Miles
NNEESESSWWNW Feet
000000 O' "d
o Definableint6rSection.
r bridge, or railroad crossing
oc
Miles
NNEESESSWWNW
00000000 of
"
First,Middle)
.' L..U ,'1 t-.j i....):~< City State Zip
-
,- " i_~'t:. -- - , .. " i - ....
-
,.;. -'" J'
Dri.Jer's License Number
-+,
..,...
Citation
Charge
3.
f.
2.
4.
Sheet
of
Law Enforcement Case Numbers'
Legal
Intervention?
Private
Property?
o
o
County:_Route:
X-Coordinate:
.,,,~.,
Y-Coordinate:
If Divided Highway. Provide Route
(Cardinal) Travel Direction
NB SB EB WB
000 0
City
1 None 3. Urine 5. Vitreous Test Results: Drug 1 None 3. Urine
2 Blood 4. Breath 9, Refused Test Given? U 2. Blood 9, Refused
State
Zip
Private?
o
Pos. Neg.
o 0
Year
.
Altachedto
Power Unit:
State
Conlributlng Circumstances, LLJ LLJ
Driver (up to two)
Year Emergency U
Status
Zip
State
Year
AUachedlo
TrailerUnil:
Carrier
Name
US DOT# or MC#
o 0
Placard# I
City
City
Gross Vehicle
Weight Rating
Driver's Name (Last. First, Middle}
F' .
Date of Birth
.' '". ; '~J
Driver's License Number
Citation
Charge
Male Female State
o 0
2
4
HazardOUSMalllfialSU
I,U Released?
State
Zip
~'r" ---r:-
1 None 3. Urine 5. Vitreous Test Results: Drug 1 None 3. Urine
2 Blood 4. Breath 9. Refused Test Given? U 2. Blood 9. Refused
City State
P06. Nag.
o
LU LU First Event
LJ-.-J LU Second Event
LU U--.J Third Event
LU LU Fourth Event
------------------------
LLJ LLJ Most Ha;;"'ul Event
(by vehicle)
LLJ
U
N
r
T
Owner's Name (Last. First, Middle)
Insurance Co
Name 1-.',
,~.- ~.-.
License
Plate # .,~ l.) --<. ..-....,.
T~#
2
Private?
o
Commercial Trailer Attached to
License Plate # Power Unit:
Carrier
Name
US DOT# or MC#
o 0
State Year
Allach~dto
Trailer Unit:
S~I&
Year
City
Placard #
If Property other than
vehicles damaged e:o:plain
Owner's Full Name
(last, First, Middle)
Street or
RFD
ACCIDENT ENVIRONMENT
Object
Damaged
Unit 1
u
1-Yes 9-Unknown
2-No
City. State,
&ZipCode
ROADWAY CHARACTERISTICS
WORK ZONE RELATED?
o Yes 0 No
Locallon of First Harmful Event U
Major Contributing Circumstances
Weather Conditions
(up to two)
LLJ
LLJ
U
U
LLJ
Environment
U Location
U Type
U Workers Present?
Manner of Crash/Collision U
Light Conditions U
Roadway
Surface Conditions
Type of Roadway Junction/Feature LU
~.-
Officer's Name --;-:~." .J' ;. h ..... '"
.i
'.
.-~ '-YVV,.,? j.
r,\
, I
Badge No. :;' 7
Zip
YeaI
Zip
I -u ~:i~~:~ Materials U
Unit 2
SEQUENCE OFEVENT
First Harmful Event of Crash
use codes 11-42 only)