Claim by Hennessey FortmanCity of Dubuque
City Council Meeting
Consent Items # 02.
Copyrighted
July 15, 2024
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Ross Dolphin for vehicle damage; Felderman Realty for property
damage; Hennessey Fortman for vehicle damage; Olivia Hansen for
property damage; Richard Hess for property damage; American Marine
for vehicle damage; Othman Mokhantar for property damage; Sarah
Weekley for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description
Claim by Felderman Realty
Claim by Ross Dolphin
Claim by Hennessey Fortman
Claim by Olivia Hansen
Claim by Richard Hess
Claim by American Marine
Claim by Othman Mokhantar
Claim by Sarah Weekley
Type
Supporting Documentation
Supporting Documentation
Supporting Documentation
Supporting Documentation
Supporting Documentation
Supporting Documentation
Supporting Documentation
Supporting Documentation
MVM
LoA
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: SbS [k) / 74-h Sl-
City: State: X11q Zip: �5Zool
3. Telephone Number: �lY �j� 2(� —7 3
4. Date of Incident: U _ 21;- 76
5. Time of Incident:
6. Location of Incident (Be specific): (VK% dk br hey-y k 5-6S�- w /7f" Sy-
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.)
8. What were weather conditions like?
9. Give name and address of any witnesses: 5 I 1 v bi rifv ) W-U+
10. Did police investigate? (If so, give names of officers.)
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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 damages or describe basis for ascertaining extent of
damage.)
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13. What other damages do you claim, if any?
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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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15. What amount do you claim from the City of Dubuque? �006 1; vim_
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
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*ated at Dubuque, Iowa this am? 'Y day of
(Signature)
(Print Name)
(Rev. 5118)
City of Dubuque
City Council Meeting
Consent Items # 03.
Copyrighted
July 15, 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: Ross Dolphin for vehicle damage; Felderman Realty for
property damage; Hennessey Fortman for vehicle damage; Olivia Hansen for
property damage; Richard Hess for property damage; American Marine for
vehicle damage; Othman Mokhantar for property damage; Sarah Weekley for
vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description
I CAP Referral
Type
Supporting Documentation
THE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Brad M. Cavanagh and
Members of the City Council
DATE: 7/2/2024
RE: Claim Against the City of Dubuque by Hennessey Fortman
Claimant Date of Claim Date of Incident Nature of Claim
Hennessey 6/28/2024 6/25/2024 Vehicle Damage
Fortman
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 the Iowa Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Steve Fehsal, Park Division Manager
Hennessey Fortman
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