Claim by Robert LangeCL 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 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: ME2 i - %� - ti6
2. Address: �5 0 CPS— 1/4 z -LEc-' F cc •
3. Telephone Number (c3) 7-c /9_ 6'30 6'
4. Date of Incident: G / / 1 / I gat9
5. Time of Incident: Oct GO
6. Location of Incident (Be specific):
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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.)
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8. What were weather conditions like?
9. Give name and address of any witnesses:
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).
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 o f dama e.)
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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.)
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15. What amount do you claim from t
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fje City of Dubuque?
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16. Why do you claim the City of Dubuque is responsibl ?
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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.)
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18. If the answer to Question 17 is yes, have you received any payment fror that
source, and if so, in what amount? ,J
Dated this / .2 f day of c� , 20 1 .
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(Signature)
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(Print Name)
January 13, 2014
Chief Brown,
On Saturday morning, 01/11/2014, we had an incident occur while performing our
weekly chores at Station 5.
We had the portable generator running outside in its usual spot near the electrical plug.
After washing the engine, I went to pull it out onto the apron in order to clean the apparatus
floor. As I was pulling out, I visually thought that I had clearance from the generator. I was
about 2/3 of the way out when I heard a small bang. I got out to investigate and found that I
had clipped the right handle of the generator and wedged the unit between Engine 505 and
Lt. Bob Lange's personal vehicle, which had been parked in the parking spot on apron.
Bob's truck sustained a small, approximate 6" diameter indentation as well as a couple
paint scratches on the driver's side rear bumper panel. 505 sustained some minor scuffs and
small indentations on the center of the EMS compartment roll -up door (first door behind
pump, officer's side). The door still works properly.
The right handle of the generator was bent forward. With our tools at the station and
through the city garage, the handle has been fixed and mounted back to the generator.
Just to note, the conditions on the driveway were relatively icy that morning from the
inclement weather. It is a possibility that the generator may have shifted due to the
vibrations while running.
Sincerely,
Mark Weitz, FEO