Claim by Roger WilmingCity of Dubuque
City Council
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Copyrighted
November 4, 2024
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Jacqueline Fetter for personal injury; Roger Wilming for
vehicle damage; State Farm Mutual Insurance a/s/o Casey
Smith for vehicle damage.
SUGGUESTED Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Claim by Jacqueline Fetter
2. Claim by Roger Wilming
3. Claim by State Farm Mutual Insurance Co aso Casey Smith
Page 111 of 2498
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA Ck-°
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: M666t (J) 16A4
2. Address: 'i7 f 7 JF-tJ t F
City:
3. Telephone Number: `&
State:
4. Date of Incident: 14 0 C' i 2
5. Time of Incident: CIO
6. Location of Incident (Be specific):
Zip: 5 2,::?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.)
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Page 114 of 2498
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?
X-JO
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.)
-` 0
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible? C 2�
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) 0
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 ti� day of 06�i� , 20Z4.
0
(Rev. 9124)
Signature)
(Print Name)
Page 115 of 2498
Copyrighted
November 4, 2024
City of Dubuque
City Council
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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: Jacqueline Fetter for
personal injury; Roger Wilming for vehicle damage.
SUGGUESTED Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
1. ICAP Referral
Page 118 of 2498
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: 10/22/2024
RE: Claim Against the City of Dubuque by Roger Wilming
Claimant Date of Claim Date of Incident Nature of Claim
Roger Wilming 10/17/2024 10/16/2024 Vehicle Damage
This is a claim in which Claimant alleges Claimant's right -side mirror was damaged after
it struck a City vehicle.
This claim has been referred to the Iowa Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Arielle Swift, Public Works Director
Roger Wilming
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
Page 120 of 2498