Claim by Jackson RahmanCopyrighted
December 19, 2022
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: C E I AS Mediacom Communications Corporation for vehicle damage;
Jackson Rahman for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by CEI ASO Mediacom Communications Supporting Documentation
Corporation
Claim by Jackson Rahman Supporting Documentation
CLAIM AGAINST THE
This written report constitutes your claim
complete this form in full and attach any a
The Claim must be filed with the City Clerk at
will then be referred by the City Council to
Once that investigation is completed, a repor
City Council. You will be provided with a cop
THE FINAL DECISION ON ALL CLAIMS IS M,
THE CITY OF DUBUQUE HAS THE AUTHOR
AS TO WHETHER YOUR CLAIM WILL OR WI
1. Name of Claimant: J QC%
2. Address:
City:
3. Telephone
4. Date of Incident: \ V- J —
5. Time of Incident:
6. Location of Incident (Be specific):
7. DESCRIBE ACCIDENT OR OCCURREN
full details upon which you base your cla
employee's name.)
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give name
11. Was anyone injured? (If so, give names,
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LeyCk-k
John Klos+rr.O,,,,
OF DUBUQUE, IOWA
nst the City of Dubuque, Iowa. You should
)nal information that supports your claim.
:ity Hall, 50 W. 131h St., Dubuque, IA 52001. It
he appropriate department for investigation.
and recommendation will be submitted to the
of that report and recommendation.
BY THE CITY COUNCIL. NO EMPLOYEE OF
TO MAKE ANY REPRESENTATION TO YOU
NOT BE PAID.
r
THAT CAUSED INJURY OR DAMAGE. (Give
If a City employee was involved, give the
of officers.)
v
ddresses, and extent of injuries).
12. Was any damage done to property?
damages. Attach estimates of damages
damage.)
13. What other damages do you claim, if a
' so, describe property and the extent of
describe basis for ascertaining extent of
i\m MyO r MY'
V'clV,
v
14. Have you been compensated for any art or all of your claim by any insurance
company? (If so, give name and address of i surance company and amount paid.)
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15. What amount do you claim from the City of Dubuque? —' t �$
16. Why do you claim the City of Dubuque is responsible?
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17. Have you made any claim against anyone Ise for damages as a result of this incident?
(If yes, give name and address.)
18. If the answer to Question 17 is yes, hav you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this 02 day of December 20 22
fA M'
(Rev. 5/18)
nature)
(Print Name)
City of Dubuque
City Council Meeting
Consent Items # 03.
Copyrighted
December 19, 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: CEI ASO for vehicle damage; Julie Fry for property
damage; Jackson Rahman for vehicle damage; Beth Whisler 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: 12/13/2022
RE: Claim Against the City of Dubuque by Jackson Rahman
Claimant Date of Claim Date of Incident Nature of Claim
Jackson Rahman 12/2/2022 11/5/2022 Vehicle Damage
This is a claim in which claimant alleges Claimant's vehicle was damaged due to being in
an accident caused by a stop sign improperly placed at an intersection.
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
Jeremy Jensen, Chief of Police
Jackson Rahman
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