Claim by Claudette Coleman Copyrighted
November 5, 2018
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Claudette Coleman for vehicle damage, Eagle Window&
Door for property damage, Lori Lewis for vehicle damage,
and Sandra Wolbers for personal injury.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City
Attorney
ATTACHMENTS:
Description Type
Coleman Claim Supporting Documentation
Eagle Window& Door Claim Supporting Documentation
Lewis Claim Supporting Documentation
Wolbers Claim Supporting Documentation
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA �, l�L ��YI�� '
This written report constitutes your claim against the Cit of Dubu ue lowa. You �h��f7�
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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. 13t" 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 thafi 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 REPRESEfVTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: L,���a��,� c��� �.,�
2. Address: �5�,� Spn���� 2� c:+c ��
City: ���c,� c� u.� State: l 1� Zip: �a.��1
3. Telephone Number: �t., ;�-- ��-��. c.; �-�;��
4. Date of Incident: ��� �
5. Time of Incident: � .-�Q_����
6. L.ocation of Incident (Be specific): u.S ��, � �.v t���-t� s�" � L �-t'`�'� �
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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
employee's name.)
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8. Wh at w e r e w e a t h e r c o n d i t i o n s l i k e? ��, ,.,5 e�;�w�-'' �x,�,�.;-t-;�;,� ��..r�;b,�:t-�p
9. Give name and address of any witnesses: S���� C«�@,�,, � �,.�r �,-.�;�.�,�
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). li
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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.)
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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 the City of Dubuque? ���,;,,,, t�- �� o�`i��`r 3�
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16. Why do you claim the City of Dubuque is responsible? .
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17e Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and acfdress.)
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18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, lowa this 1 �� day of � , 20 ��.
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(Print Name)
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Copyrighted
November 5, 2018
City of Dubuque Consent Items # 3.
ITEM TITLE: Disposition of Claims
SUMMARY: City Attorney advising that the following claims have been
referred to Public Entity Risk Services of lowa, the agent
for the lowa Communities Assurance Pool: Claudette
Coleman for vehicle damage, Eagle Window& Door for
property damage, Lindsay Lannen for property damage,
Lori Lewis for vehicle damage, Sandra Wolbers for
personal injury.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Supporting Documentation
°THE CITY OF �
I��TB E MEMORANDUM �
Masterpiece on the Mississippi I'
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TRACEY STECKLEIN ,���
PARALEGAL
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To: Mayor Roy D. Buol and
Members of the City Council �
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DaTe: October 18, 201�8 �
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RE: Claim Against the City of Dubuque by Claudette Coleman '���
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Claimant Date of Claim Date of Loss Nafure of Claim
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Claudette Coleman 10/15/18 09/13/18 Vehicle Damage !i
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This is a claim in which daimant alleges that a Public Works employee driving a salt truck ;�
traveling northbound in the east Lane on White Street near E. 17t" Street crossed the 'i
center line and struck claimant's vehicle. ;;
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This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa I'j
Communities Assurance PooL �
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cc: Michael C. Van Milligen, City Manager �
John Klostermann, Public Works Director Ij
Claudette Coleman �
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OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TE�EPHONE (563)583-4113/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org
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