Claim Lampers, TroyCLAIM 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: Troy Lampers
2. Address: 640 Greenfield, Dubuque IA 52001
3. Telephone Number: 563-583-7311 ext 326
4. Date of Incident: 12/7/06
5. Time of Incident: 9am
6. Location of Incident (Be specific): Intersection of 17th and Jackson.
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 truck pulled into the intersection. He had the stop sign and another vehicle was coming so he stopped in the middle of the intersection. The vehicle in front of the insureds vehiclde pulled around the city truck and the insured started pulling around the city truck. The insured did not have a stop sign, but the city truck didn't see him and struck the passenger side of the Blazer.
8. What were weather conditions like? No rain or snow
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.) Yes. Officer Berkley. Badge No. 84
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. 1990 Chevrolet Blazer. Passenger front. Estimate says cost of repairs exceeds value of vehicle.
13. What other damages do you claim, if any?
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? Suggested retail value ($2,000)
16. Why do you claim the City of Dubuque is responsible?
The driver was driving an official city truck, and the driver of the truck was at fault.
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 this 7th day of December, 2006.
(Signature)
(Print Name)
. DEC-07-20Q6 THU 01: 31 PM FRIEDMAN INSURANCE
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11, Was anyone Injured? (If so, give names, addresiSe6, and extent of injuries).
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12, Wesany dam.ge !:lone to property? (II so, dellcribe property and the eld:8nt
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13. What other d"mages do YOLl claim, if any?
14. f1ave you been Compensateel for any part or .11 of your claim by .SIIlY
insurance QO/Tlpany? (/1 so, give name and Ilddress of Insurance company and
~nt Paid'No.
15, What amount do vall c1a~rror the city of PUbU~~? )
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16, Why (fo you claim the City of Dubuque Is responsIble? . .'.J ..J.J. d
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17. Have you made any claim against llnyone else for damages IS a result of .
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18, If the answer to Question 17 Ie yee, have you reoel'ied IIny plymlnt from that
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. DEC-07-20g6 THU 01:31 PM FRIEDMAN INSURANCE
FAX NO, 563 556 4425
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estimate ID: '834
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Lenny Valentine &1 Sons, Inc"
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UNIBOpr SPEFIALISTS
Damage Asee...~ By: WAYNE VALENnNE
DIlduCllble: UNKNOWN
Owner TROY l.AMPE'RS
Ad~re..: 640 GREENFIELD ST DUBUQUE, IA 52001
T.lephon.: liom. Phone: 111131582-1714
lleeeripUon: 1990 Chevrolel S10 Blllbr
Body Style: 2D Uj 100"1NB
Mitchell S.rvi..: 913488
DriVe Troin: 4.3L Inj 6 Cy, 4IND
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- DEC-07-2006 THU 01:31 PM FRIEDMAN INSURANCE
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