Claim by Mary LeGrand and David SmithCopyrighted
November 20, 2023
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Abigail Handke for vehicle damage; Mary LeGrand and David Smith for
property damage; District 20 Supply Co./Dennis Noel for vehicle
damage; Donovan Tann for property damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Abigail Handke Supporting Documentation
Claim by Mary LeGrand and David Smith Supporting Documentation
Claim by District 20 Supply Co./Dennis Noel Supporting Documentation
Claim by Donovan Tann 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:
2. Address: 1
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City: State: 1=% Zip:15J 00'-L
3. Telephone Number:(p�c:3�`�
4. Date of Incident: �J1Y7&1rj v61 f/Z 4nT-
5. Time of Incident. q-
6. Location of Incident (Be specific): _
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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.)
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8. What were weather conditions like? ZZ)OP41 fYIIJI
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9. Give name and address of any witnesses: Of ' 0W/
10. Did police investigate? (If so, give Hama¢ of ,offic rc_1
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.)
13. What other damages do you claim, if any'21 rd aC ;hee and eyg ,
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1d Have you been comnnnsated 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.
16. M do you claim the City of,Dubuque is responsible? ,
17. Have you made any claim against anyone else for smages 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 sniiircP-
and if so, in what amount?
Dated at Dubuque, Iowa this 10 day of JUCf V e, i'AG &-v- 201
�10
(Rev. 5/18)
(Signature)
(Print Name)