Claim by Mary Burke Copyrighted
October 16, 2023
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Jill Boge for vehicle damage; Mary Burke for vehicle damage; Linda I rish
for vehicle damage; J P Gasway Co I nc for vehicle damage; Lori Meyer
for property damage; Mercy One Medical Center for property damage;
Erica Nelson for vehicle damage
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Jill Boge Supporting Documentation
Claim by Mary Burke Supporting Documentation
Claim by Linda Irish Supporting Documentation
Clim by Mercy One Medical Center Supporting Documentation
Claim by Lori Meyer Supporting Documentation
Claim by Erica Nelson Supporting Documentation
Claim by J P Gasway Co Inc Supporting Documentation
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CLAIM AGAWST THE C1TY 4F DUBUQUE, IOWA ��CY������`
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This writ�en report constitufes your claim against the C�ty of Dubuque, lowa. You should
complete this form in fu11 and attach any additional information that sup�orts your claim.
The Claim must lae filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001. !t
wilf th�n be referred �y the City Council to t�e ap{�ropria�e department for investfgation.
Once that investigation is cotnp�eted, a report and recommendation will be submitted #o the
City Council. You wili be pro�ided with a copy of#hat repart and recommendation.
THE FlNAL D�CISION ON ALL CLAIMS IS MADE BY THE C1TY CAl1NClL. NO �MPLOYEE OF
THE CITY OF DIJBUQUE HAS THE AUTHQRITY TQ MAKE ANY REPRESENI'ATlON TO YO�
AS TO WHETHER YOUR CLAIM WIL� OR WtLL NOT �E PA1D.
1. Name of Claimant: �"�C7/��r /� , �J �- ��
2. Address: f � �, �--�� �.
City: L� � - State: :�U�,,✓ Zip: ; �c��C�/
3. Telephone Nt�mber: .`.�� � 'y" - �.3� `�7
4. Date of Incident: � � � �� � � � �
5. Time of Inc�dent: : � `� '��
fi. Location of Incid�nt (Be specific}: ' � ' %"] �„� `;�A �- - -� �:�����
���-� 'J�;� , % .� i.J� .P.�--�����
7. DESCRIBE ACCIDENT OR OCCURRENC� THAT CAUSED INJURY OR DAMAGE. (Gi�e
full detiaits upan which you base your claim. If a City employee was ir��olved, gi�e the
employee's name.J
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8. Wha# were weather conditions like? ���� ��Lr�f�fl`�
9. Give name and address of any witnesses: i���i.�'���i� ��>�><<r.� � ��":, F i �[S�
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10. Did polFce ir�vestigate? (!f so, give names of afficers.� ��
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I� C± l`t I��j'%U '1 G t=N ('• A '�,=_ �- � (�: ,� �. - �'j�i ,� 3�
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11. Was anyane injur�d? {If so, give names, addresses, and exte�� of injuries).
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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.)
`'�C�I� �--��?l� -� [�"�� ��iT'l� 1�C,o�' /�-�1/� �lT�
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13. What other damages do you claim, if any? _C,���• � --��"-'� CZ..UJ��'
� Q4� � L'i�d�1 L
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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75. What a���d,p y� claim from the City of Dubuque?
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16. Why do ou claim the City of Dubuque is re ponsible?
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, giv�a�e and address.)
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what ampunt?
N/A
,
Dated at Dubuque, lowa this � day of ,S"/_�Y� , 20�
f � (Signature)
�'✓ � L�U�� (Print Name) „�;
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Confidential
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) BankAccountlnformation
5) Financiallnformation
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.
I, ,�'���� �''1 �(.l��l'C , hereby certify that the attached documents
include the t'ollowing protected information:
�� Social Security Number(s) �Bank Account Information
/�/0 Medical/Health Information 1(7 Financial Information
I�1� Personnel/Disciplinary Information _�Credit Card Number(s)
I understand that this information may be distributed within the City arganization or to agents of the
City for processing and I hereby authorize the City to act accordingly taking all precautions to
protect my information from unnecessary distribution.
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Signature Date .
Copyrighted
October 16, 2023
City of Dubuque Consent Items # 03.
City Council Meeting
ITEM TITLE: Disposition of Claims
SUMMARY: CityAttorneyadvising thatthe following claims have been referred to
Public Entity Risk Services of lowa, the agent for the lowa Communities
Assurance Pool: J ill Boge for vehicle damage; Mary Burke for vehicle
damage; Linda I rish for vehicle damage; Lori Meyer for property
damage; Erica Nelson for vehicle damage; J P Gasway Co I nc for
vehicle damage
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description Type
PERS Jill Boge Supporting Documentation
PERS Mary Burke Supporting Documentation
PERS Linda Irish Supporting Documentation
PERS Lori Meyer Supporting Documentation
PERS Erica Nelson Supporting Documentation
PERS- P J Gasway Supporting Documentation
THE CTTY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
� ONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Brad M. Cavanagh and
Members of the City Council
DATE: 10/3/2023
RE: Claim Against the City of Dubuque by Mary Burke
Claimant Date of Claim Date of Incident Nature of Claim
Mary Burke 9/29/2023 8/21/2023 Vehicle Damage
This is a claim in which claimant alleges Claimant's vehicle was damaged when a tree on
City property fell onto it.
This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Steve Fehsal, Park Division Manager
Mary Burke
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944
TE�EPHONE (563)589-4113/Fax (563)583-1040/EMai� jmedinge@cityofdubuque.org