Claim by Arius Burns and Hayle JohnsonCopyrighted
November 6, 2023
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Arius Burns and Hayle Johnson for property damage; Laufenberg and
Larson Properties LLC for property damage; Smokestack - Susan Price
for property damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Arius Burns and Hayle Johnson Supporting Documentation
Claim by Laufenberg and Larson Properties LLC Supporting Documentation
Claim by Smokestack Susan Price Supporting Documentation
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA OWLS L-,ES+(!l
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. 13th 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: US 6 0rr)�, 0-n j a hm�
2. Address:R�Q,
City:Cie State: ( _ zip:I
3. Telephone Number:�OoZ3`_
4. Date of Incident: � 1 a
5. Time of Incident: am,
6. Location of Incident (Be specific): � ia9- (�, b--,4-(Drv1 C
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.) ki cc r+^2 fc� fix es f�.,� Y►'�-Q �ct� -I-h:Qy !J0r- Cl
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8. What were weather conditions like? d 1
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9. Give name and address of any witnesses: 0—a—nAN& ovka Q
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent 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 damage or describe bas' for ascertaining extent of
damagge.)�Q �G� ,`c�'2�10 vv�S Cv� ► �jpC UPJvv� �Yj � q ( kja 5 !hnQ Ck>��eb
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13. What other damages do you claim, if any? 1+&Vi!2C VtLp tj <Dd' -
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
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16. Why
17. Hav6 you m�
(If yes, give nam
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claim from the City of Dubuque?
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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 o% day of OCA-ot9kx 20k.
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(Rev.5/18)