Claim by Barbara CallhanConfidential
This communication and any attachments may contain information which is confidential
and privileged by law and is for the use of the designated recipient. If you are not the
intended recipient, you are hereby notified that you have received this communication in
error, and that any review, disclosure, dissemination, distribution or copying of its contents
is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of
your receipt of these items and destroy the communication and any attachments
immediately. Further disclosure of this information may violate state and federal
restrictions.
Confidential information may include the following:
1)Social Security Number(s)
2)Medical/Health Information
3)Personnel/Disciplinary Information
4)Bank Account Information
5)Financial Information
6)Credit Card Numbers
If any documentation you desire to submit to the City of Dubuque contains any of the items above
this cover sheet must be attached directly to the confidential information and indicate the type of
information that is included.
Jenny Cribbs , hereby certify that the attached documents
include the following protected information:
Social Security Number(s) Bank Account Information
Medical/Health Information Financial Information
Personnel/Disciplinary Information Credit Card Number(s)
I understand that this information may be distributed within the City organization or to agent's of
the City for processing and I hereby authorize the City to act accordingly taking all precautions to
protect my information from unnecessary distribution.
Signature
10/28/22
Date
CLAIM 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. 13t" St., Dubuque, IA 52001.
It will then be referred by the City Clerk 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.
1. Name of Claimant:
2. Address:
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
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.)
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
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 of damage.)
No property damage
13. What other damages do you claim, if any? No
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 money has been paid yet but insured is scheduled for repairs.
15. What amount do you claim from the City of Dubuque?
Unknown at this time
16. Why do you claim the City of Dubuque is responsible?
City Bus Driver was cited in accident
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?
No
Dated at Dubuque, Iowa this 28 day of October 2022
(Signature)
Jenny Cribbs
(Print Name)
City of Dubuque
City Council Meeting
Consent Items # 03.
Copyrighted
November 21, 2022
ITEM TITLE: Disposition of Claims
SUMMARY: City Attorney advising that the following claims have been referred to
Public Entity Risk Services of Iowa, the agent for the Iowa Communities
Assurance Pool: Ethan Bever for vehicle damage; Barbara Callhan for
vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description
I CAP Referral
Type
Supporting Documentation
THE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Brad M. Cavanagh and
Members of the City Council
DATE: 11 /9/2022
RE: Claim Against the City of Dubuque by Barbara Callhan
Claimant Date of Claim Date of Incident Nature of Claim
Barbara Callhan 10/28/2022 9/16/2022 Vehicle Damage
This is a claim in which claimant alleges Claimant's vehicle was damaged due to being
struck by a City bus.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Ryan Knuckey, Director of Transportation Services
Barbara Callhan
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 589-4113 / FAx (563) 583-1040 / EMAIL jmedinge@cityofdubuque.org