Claim by State Farm Mutual Insurance Co aso Casey SmithCity 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���
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: State Farm Mutual Ins Co a/s/o Casey Smith
2. Address: PO Box 106172 Atlanta, GA 30348-6172
3. Telephone Number: 877-787-8276
4. Date of Incident: 7/9/24
5. Time of Incident: 8:05 AM
6. Location of Incident (Be specific): Ashbury Rd Dubuque IA
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.)
City vehicle being driven by James Brosius struck insured vehicle being driven by Casey Smith.
8. What were weather conditions like? n/a
9. Give name and address of any witnesses: n/a
10. Did police investigate? (If so, give names of officers.)
Yes PR 2024004804 Dubuque PD
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
n/a
Page 116 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.)
Insured vehicle sustained damage to Door(s) PS,Rear Bumper,Rear End
13
What other damages do you claim, if any? n/a
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.)
n/a
15. What amount do you claim from the City of Dubuque?
$3,123.01
16. Why do you claim the City of Dubuque is responsible?
City is responsible for improper lookout.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
n/a
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
n/a
Elizabethtown, PA
Dated at 113mbellque, 0 a this 9th day of October 2024
State Farm Mutual Ins Co a/s/o Casey Smith (Signature)
Kelley Flenke State Farm Mutual Ins Co a/s/o Casey Smith
(Rev. 7/12)
(Print Name)
Page 117 of 2498