Claim by David HawkinsCopyrighted
June 20, 2023
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Kyle Cross for personal injury/property damage; David Hawkins for
property damage; Mary Koppes for property damage; Robert Lynn for
property damage; Alexis Lyons for property damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description
Type
Claim by Kyle Cross
Supporting Documentation
Claim by Mary Koppes
Supporting Documentation
Claim by Robert Lynn
Supporting Documentation
Claim by Ale)as Lyons
Supporting Documentation
Claim by David Hawkins
Supporting Documentation
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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 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: Depositors Insurance Company a/s/o David Hawkins c/o Mon;que Peebles, Litigation Specialist
2. Address: Po Box 1a2008
City: Columbus
3. Telephone Number:
4. Date of Incident:
5. Time of Incident: 8.17 AM
State: OH Zip: 43218
919-881-3443
2!9/2a23
6. Location of Incident (Be specific):
W 17th Street, Dubuque IA
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.)
Our insured's vehicle was €egally parked when it was struck by the snow plow being driven by
David Lindecker,
8. What were weather conditions like? ground snow Gavered
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Bradley Hesselbacher
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No, vehicle was parked and unoccupied
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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.)
Property Damage Hawkins Vehicle (2020 Honda Element) -left sloe
13. What other damages do you claim, if any? Insured has out of pocket expenses in the amount or
$413.77-as shown on the attached rental invoice
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.)
Depositors Insurance Company Policy
j,714J 192215 Claim # 774ay4-GO
1.5. What amount do ou claim from the City of Dubuque?
1.0 s6lG - ?I (including the $500 deductible pald by Insured David Hawkins)
16, Why do you claim the City of Dubuque is responsi
He Failed o observe proper clearance while o
the snow plow
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? N/A
Dated at Dubuque, Iowa this 8 day of June 202s
(� a!s/o David Hawkins _(i;ignature)
Monique Peebles, Depositors Insurance Company _(print Name)
(Rev.5118) - 1I
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