Claim Goetzinger, DavidCLAIM 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: David Goetzinger
2. Address: 1795 Lincoln Ave.
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3. Telephone Number: 563 556 1026 Please call - I'd like to discuss D.G.
4. Date of Incident: 12 FEB. '05
5. Time of Incident: 11:30 A.M.
6. Location of Incident (Be specific): Bicycle Path at Downhill approach to underpass of 16th St. Bridge - South bound / Westside.
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.)
Poor design of bicycle path causes water run off across trail, freezing, resulting in my bicycle tires to
slip and me to fall.
8. What were weather conditions like? Clear/Sunny 35 degrees
9. Give name and address of any witnesses: Ken Buesing, 1909 Spyglass Dr., Asbury; Mark Wittry, 3580 Pennsylvania, Dbq (Plus others)
10. Did police investigate? (If so, give names of officers.)
No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Yes, David Goetzinger (see above) - fractured femural neck right hip (3) 5" screw inserted to secure recovery & subsequent removal.
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.)
Cosmetic damage to bicycle - handle bar tape torn, scratches to pedals, salld & rear derailer.
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.)
John Deere Health Care, Inc. - (JDH - Select - $9486.23), 1300 River Drive, Suite 200, Moline, IL 61265
15. What amount do you claim from the City of Dubuque? $30,282.51
16. Why do you claim the City of Dubuque is responsible? The design of the bike path should have allowed water to drain off (not across) with an angle to inside with a culvert to drain
water underneath = and sand and gravel during summer = eliminate ice on surface!
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) No
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
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Dated at Dubuque, Iowa this 2nd day of May, 2006. , 20 .
/s/ David Goetzinger
Waited until I had recovered from accident (both surgeries).
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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This written report constitutes your claim against the City of Dubuque, Iowa. You should
complete this form in full and attach any additional information that supports your claim.
CLAIM AGAINST THE CITY OF DUBUQUE,.\OWA .
The Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for investigation.
Once that investigation is completed, a report and recommendation will be submitted to the
City Council. You will be provided with a copy of that report and recommendation.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE
OF THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO
YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: DAViD GOE-/Z./N4ER
2. Address: I 79 S- t... / N (,,0 t. II AVE,
3. Telephone Number: 503 SS6- /O~ 0
4. Date of Incident: I ~ F &/3. , oS-
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5. Time of Incident:
6. Location of Incident(Be specific): {] / C Yt '-iff- {JArl! /rr /JOltIfllltLL AfljJ}!tJ..1rV1
'16 4NlJFt<.PACS OF 16m 51: BIfIOCPE- ~1)1I'71f8O:<1{t:J).p!Z-$r9/.JL
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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
ewployee's name.)
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8. What were weather conditions like? (~ L~A IZ-~~ NN Y 3.5'0
9. Give name and address of any witnesses: !<J;/'I BUF-5iN&i - nor SfYt;.L49: DR" A~i.lRy
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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 ol 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?
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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 a~'>19t/g6,o?,~
. -:JOliN D~E f/?Aif# CA/2&> :ENe. (SDI-f -.sEC[c-r)~f!,,~'tf7)
/3CO RIflER IJRI{/E \CI/7F;100 HtJ?/A'F., -cL. 6/;;;6 \'
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15. What amount do you claim from the City of Dubuque? 13rJ/:l?d.,0 (
16. Why do you claim the City of Dubuque is responsible? .m&- OE5I~N 0 F 77f.c:- 81M fJ.#T#
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) AI 0
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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Dated at Dubuque, Iowa this {)NlJ day of
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(Rev. 1/00 & 7/01)