Claim Nesler, FerdCLAIM 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: Ferd A. Nesler
2. Address: 4125 Mt. Alpine, Dubuque, IA 52001
`
3. Telephone Number: 563 588 1774
4. Date of Incident: 6 27 06
5. Time of Incident: 2:15 P.M.
6. Location of Incident (Be specific):
3700 Block of Pennsylvania Ave.
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.)
City Employee Richard Dougherty pulled out in front of me from the
Penn Apts. when I was driving south on Pennsylvania Ave.
8. What were weather conditions like? Clear & Sunny
9. Give name and address of any witnesses:
None that I know of
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Andrew Harden
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.)
The left front fender and drivers' side mirror were damaged. The hood end drivers door will need some paint repair
and the front end will need to be realigned.
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?
$2,023.86 plus any hidden damage - if any
16. Why do you claim the City of Dubuque is responsible?
The driver pulled into my ane of traffic and received a ticket.
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?
N/a
Dated at Dubuque, Iowa this 1st day of July, 2006.
/s/ Ferd A. Nesler
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
.
;/3ID b
{' (.' &zi{/t1
I'll t/fl(
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ti~ ~
-1)., LJ.,
.?U-t'f NrZ/tA-
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 West 13th St.,
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. 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: krd A. N<",.~~r
2. Address: 'I;;}, <) JJ1T A'..fJ/AN~ / Du !I(/(fJU(o; Ta S":<('K) /
3. Telephone Number 5~3- 5BB-/77~
4. Date of Incident: 0 - ,-27 - O?~
5. Time of Incident: d:11\' fJ/l?
6. Location of Incident (Be specific):
. :f7CJO 8/~1:: ('T IbA.WS"f'Ll./ao/6. .4~.
7. Describe the 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.)
fl!;!ff.:::(/1;:fLJ.;<7j ~7u"c;;,;!,,;:; aT
8. What were weather conditions like?
t!L-Ar ~ ~DA/V
,
9. Give name and address of any witnesses:
4.1aA/e ~a:r.I.. K'A.IOW &-r.
10. Did police i~":igate? (If so, give names of officers.)
y~c 0 r FJM::J~w ;/arck""
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 damag~,"
ii IAff ..,7 fr,u./e.t:: avd drivers ...,,,", dJ.l/h>r
~ -t~~:;Jfi:]~ ;1::';!::-i~""'
13. What other damages do you claim, if any?
N"L.JC;
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.)
AI.?
.
15. What amount do you claim from the City of Dubuque? L'
$ c2,,:),;n.8~ flk( C'jA>Y IJIJdo.V rlCHJI~ _I'I aN,/,'
16. Why do you claim the City of Dubuque is responsible? fl),
~ d/"loer Ou//.&'I /AJ7b NY /~A)e 6.7 -1m. C CLlVd
r,o~/OL"3d' a!.. -r~.J-JC!-r;
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes, give name and address.)
Alo
18. If the answer to Question 17 is yes, have you received any payment from that
sourc%and if so, in what amount?
i1
c
D:;'}1 / -tj.~lb'::Y
~~ #2
(Signature)
t;>;d ;/.. j)g~
(Print Name)
,.20~.
.,c'-"
. i
I't
., '"
e,
'--, --j" --
Driver's Name. Last
U DOUGHERTY
N Address
I LEN
T Gender Driver's License Number
Male 962AA8874
001 Owner Company Name
CITY OF DUBUQUE
Owner's Name. Last
Address
50 WET 13TH STREET
VIN No.
1FDXE45P15HB19967
License Plate #
104729
Driver's Name - Last
U NESLER
N Address
I 4125 MT ALPINE
T Gender Driver's License Number
Male 767YY0270
002 Owner Company Name
,
,
.
Owner's Name - Last
NESLER
Address
4125 MT ALPINE
VIN No.
1G8ZK5279XZ354866
License Plate #
728NRZ
I County
Dubuque - 31
Literal Description
01 PENNSYLVANIA AVE
X-Coordinate
00686376
If accident occurred outside of city
limits show general vacinity:
~, Driver InfO~';2:~~~i~D~~:~ange Report
563-589.4410
Phone
(563) 667-7938 X
Insurance Co. Phone #
(563) 689-4120 X
Middle
ALLEN
,
I
i
-1
Insurance Co. Name
IOWA COMMUNITIES ASSUR.
Insurance Policy #
CITY OF DUBUQUE
Suffix
l
!
Middle
Style !Vehicle Configuration i
PARA.TRANSITBUS i 19 '
Approximate Cost to Repair or Replace
$200.00
Zip
52001-
Date of Birth
10/08/1946
Middle
AUGUST
-
!
!
Phone
(563) 588.1774 X
Insurance Co. Phone #
(800) 925.2886 X
Insurance Co. Name
PROGRESSIVE CASUAL TY
Insurance Policy #
43493900-4
Middle
AUGUST
Suffix
Zip
62001-
Style
4D
I Vehicle Configuration I
, 01 I
Approximate Cost to Repair or Repla~
$1,000.00 '
I
Accident occurred within corporate limits of (city)
Dubuque - 2100
Y -Coord inate
04707863
"N/A"
Direction I Nearest City
"N/A" of "N/A"
Route (Cardinal)
Travel Direction "N/A"
On Road, Street, or Highway:
3700 BLK. PENNSYLVANIA AVE.
Distance Direction Distance
"N/A" "N/A" a"d 600 Ft
Definable intersection, bridge, or railroad crossing
VIZALEEA DRIVE
Officer
HARDEN, ANDREW
Milepost Number
"N/A"
0,
Law Enforcement Case Number
01-06.28488
Date of Accident
06/2712006
Time of Accident ,
14:15 __~j
Printed At: Dubuque Police Department
Page 1
Form #: 01-06-28488
.
HABERKORN AUTO CENTER
OWNER
~
q 602 PI}U ROAD. DUBUQUE, IOWA 52001
~ ADDRESS
. PHONE (319) 556.8872
n<617?~4036
DATE b -.{ fr,9 06'
IM'''V,* YEAR MODEL '5~ L liJ7 IOENTIFICATIONNQ I MILEAGE !"7ZiT,NA'zl
9'9' ~
FRONT OF CAR '" "e' SUBLET & PARTS LEFT SIDE '" "e, SUBLET & PARTS RIGHT SIDE '" "e, SUBLET & PARTS
MATERIAL MATERIAL MATERIAL
BUMPER ~ 1.0 11 S- HEADLIGHT HEAOLlGHT
BUMPER SRKT. COMPOSITE I.Q 1/.0 COMPOSITE
BUMPER GUARD
GRILL PARKING, LIGHT PARKING, LIGHT
GRILL FENDER, FRONT N II, << 3,0 11 "" 'I-~ FENDER,FRONT
GRILL MLDG. FENDER, APRON FENDER, APRON
FENDER MLDG. FENDER MLDG.
GRAVEL SHIELD FENDER MLDG. FENDER MLDG.
WINDSHIELD FENDER MLDG. FENDER MLDG.
HEADER PANEL FENDER MLDG. FENDER MLDG.
DOOR, FRONT R 11..J- J.,7 DOOR. FRONT
COWL DOOR, MLDG. DOOR, MLDG.
RAD. SUPPORT DOOR GLASS DOOR GLASS
RAD. CORE VENT GLASS VENT GLASS
rtJ~J " ^' . r '" ~p
ANTI FREEZE CENTER POST CENTER POST
FAN BLADE
FAN SHROUD DOOR, REAR DOOR, REAR
DOOR, MLDG. DOOR, MLDG.
DOOR GLASS DOOR GLASS
HOOD IR IT ~ l,i)
HOOD HINGES
HOOD MlDG. ROCKER PANEL ROCKER PANEL
ROCKER MlDG. ROCKER MlDG.
FLOOR FLOOR
ORNAMENT 1/4 PANEL 1/4 PANEL
NAME PLATE 1/4 PANEL 1/4 PANEL
lOCK PLATE, lR. 1/4 PANEL 1/4 PANEL
lOCK SUPT. WHEEL HOUSE WHEEL HOUSE
1/4 MlDG. 1/4 MlDG.
REAR OF CAR
BUMPER
BUMPER BRKT.
BUMPER GUARD TAilLIGHT TAilLIGHT
TAilLIGHT TAilLIGHT
TAilLIGHT TAilLIGHT
GRAVEL SHIELD TAilLIGHT TAilLIGHT
lOWER PANEL BACK-UP LIGHT BACK-UP LIGHT
FLOOR BACK-UP LIGHT BACK-UP LIGHT
TRUNK LID CLEAR COAT }l IJ.O ~ ~
TRUNK HINGE CLEAN~UP
TRUNK MlDG. LABOR HRS. @ 410 00
MISC. ITEMS PARTS Cf-I/ ~6
TOP IDENTIFICATION PAINTING " q.O ()1J
LICENSE LIGHT FRAME KEY TOWING
TIRES MATERIAL fZiTA 0 ~O
HUBS CAPS N NEW HAZARDOUS t t7
R REPAIR WASTE
WHEEL DISC. OH OVERHAUL
14..... Y L 1.0 h~ tJ, A ALIGN 1 :.., ~ ~D
p PAINT TAX
S SUBLET
The above is an estimate based on Our inspection and does not COver additional pa<"ls or labor which may be required atter work has begun. Occasionally, when work is TOTAL A O;Z 3 C{{
opened up, we d,scover worn, broken or damaged parts not evident in the first inspection. Quotations on parts and labor are currenl ands ubject to change.
ESTIMATED BY
WORK AUTHORIZED BY
ESTIMATE