Claim by Melinda HarbaughCLAIM AGAINST THE CITY OF DUBUQUE, IOWA
ltc�ccl
Jilin �'toSict m>rn
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. 131h 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: M e h r) (, )+a r b a u
2. Address:
City: l i lit) CJl) a State: --U LU cc- Zip: Sa b
3. Telephone Number: 5 (n 3- C1' 5 9 F
4. Date of Incident: a 01 i ` .-) 0 -� 0
5. Time of Incident: (Y p4 t7 M (�.
6. Location of Incident (Be specific): l c? i Ka v fYmo- rl, A u e , b U 0 U C
llq 5(9100/
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.)
SeHlinq o� Fran+ porck p2ijars brnk.en il ncjcl1is
ULk PGI C�-'r y\q Vrl
wculc.
8. What were weather condi ions like. M I Li
9. Give name and address of any witnesses: c,Qrl nC(D&c e ne. r1 % �
10. Did police investigate? (If so, give names of officers.)
NSA
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.)
V L _, s e f-Hi
ng ci Lo(YI
porch
i \ Icy �S
hrotx-n u)\r,douys,
and
,
ng 1jamuae
A-0
-Ivc_Ic
ooio-hcn nn
ba)e-mQ-rd
tooLls
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.)
15. What amount do you claim from the City of Dubuque?
-V=cr ro nn �C fir^ n,V _1-ka V- n'%
'A1
16. Why do you claim the City of Dubuque is responsible? NO
d CJ-MC-9 e wc,s vu) s-hr�
126oy- +,—,, vcoMi') The 5tr �i k�)w dun t n 3 -hmes
17. Have you ma a any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
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, Iowa this U day of 00-Ob-er 20 4.
MO1 nd a - av bavo,�
(Rev. 5/18)
(Signature)
Name)
�v
---
r-
v
_
v
City of Dubuque
City Council Meeting
Consent Items # 03.
Copyrighted
December 5, 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: Melinda Harbaugh for property damage; Leah Wieseler
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 /22/2022
RE: Claim Against the City of Dubuque by Melinda Harbaugh
Claimant Date of Claim Date of Incident Nature of Claim
Melinda Harbaugh 10/6/2022 2019-2022 Property Damage
This is a claim in which claimant alleges Claimant's home has been damaged due to
street repairs which caused her home to settle.
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
John Klostermann, Public Works Director
Melinda Harbaugh
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