Claim by Keon KillinsCity of Dubuque
City Council
ITEM TITLE:
SUMMARY:
SUGGUESTED
DISPOSITION:
ATTACHMENTS:
Copyrighted
November 18, 2024
CONSENT ITEMS # 2.
Notice of Claims and Suits
Halanier Holmes for vehicle damage; Jamie Joe Doyle for
vehicle damage; Keon Killins for vehicle damage,
Receive and File; Refer to City Attorney
1. Claim by Halanier Holmes
2. Claim by Jamie Joe Doyle
3. Claim by Keon Killins
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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: V1 C CN\
2. Address: �9 WXv'y1
City: Nlo\a4t
3. Telephone Number:'
4. Date of Incident: k%C3\I2C'Z\A
State:'G
Zip: �}Lt
5. Time of Incident:
6. Location of incident (Be specific): '-Ivl t3�.�H�s' � S�ysaG tc �\ly
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?��i�`R�1�
-� 9.
Give name and address of any witnesses: '+ k
10. Did police investigate? (If so, give names of officers.)
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?
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.)
�f"'�D i�CGcy CUB '� vr� uJ' W�►� a.� ����'`-1C�1,)
�.}15. What amount do you claim from the City of Dubuque? i
�'C t.� �° % per �,b VI�UL ig �it`� �►1Dit
16. Why do you claim the City of Dubuque is responsible? �ocCX\gSt Wt `h'Vt ,,`, S OVk
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) V ca
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 -7 day of 20-LI .
1 '� 1 tCU�, (Signature)
(Print Name)
(Rev. 9/24)
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