Claim by Kami AdolfCopyrighted
February 19, 2024
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Kami Adolf for vehicle damage; April Colehour for personal injury;
Douglas Harkey for property damage; Nick May for property damage;
Natalie Oltmanns for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description
Type
Claim by Kami Adolf
Supporting Documentation
Claim by April Colehour
Supporting Documentation
Claim by Douglas Harkey
Supporting Documentation
Claim by Nick May
Supporting Documentation
Claim by Natalie Oltmanns
Supporting Documentation
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. 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.
Name of Claimant:
2. Address: ,-)o / , C(
City:'fi
�IR.S�..� State: ._� Zip:
3. Telephone Number: j Rat®
4. Date of Incident: I l �)
5. Time of Incident:
6. Location of Incident (Be specific): Lit C�� SOtk-�`k Culd U--.)y�-f-, J—,
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.)
m �a*her conditio-hs like? CCAA
9. Give name and address of any witnesses: Q tt-iC4 rn =� Ou l a L\ i-
10. Did police investigate? (If so, give names of officers.)
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? cI
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 you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
17. Have you made any claim against anyone else for damages 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 source,
and if so, in what amount?
Dated at Dubuque, Iowa this day of "V 20,
(Signature)
Gt ( 'Ad (Print Name)
Cv"
(Rev.5118)
cD C-n l w�
E
City of Dubuque
City Council Meeting
Consent Items # 03.
Copyrighted
February 19, 2024
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: Kami Adolf for vehicle damage; April Colehour for
personal injury; Douglas Harkey for property damage; Nick May for
property damage; Natalie Oltmanns for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description
I CAP Referral
Type
Supporting Documentation
THE CU�R�QbE
DMEMORANDUM
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Brad M. Cavanagh and
Members of the City Council
DATE: 2/13/2024
RE
Claimant
Kami Adolf
Claim Against the City of Dubuque by Kami Adolf
Date of Claim Date of Incident Nature of Claim
2/7/2024 11/22/2023 Vehicle Damage
This is a claim in which claimant alleges Claimant's vehicle was damaged during a traffic
stop.
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
Kami Adolf
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