Claim by Lois KampCity of Dubuque
City Council
ITEM TITLE:
SUMMARY:
SUGGUESTED
DISPOSITION:
ATTACHMENTS:
Copyrighted
December 16, 2024
CONSENT ITEMS # 2.
Notice of Claims and Suits
Lois Kamp for vehicle damage; Laura Schroeder for vehicle
damage.
Receive and File; Refer to City Attorney
1. Claim by Lois Kamp
2. Claim by Laura Schroeder
Page 84 of 1050
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 Clerk 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.
1. Name of Claimant:
2. Address:
3. Telephone Number: — 2 3 9 -Qj 0-7
4. Date of Incident:.�nn�
5. Time of Incident: 2,A m
6. Location of Incident (Be specific
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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iWhat were weather conditions�' ►,i�,l
9. Give name and address of any witnesses: Donne
10. Did police investigate? (If so, give names of officers
" Ir. Fmk Q,h4 I �''� i Maw $Or dentoe0fl�njuries).Gu11. Was anyone injured. f so, give names, addresses, and
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Page 85 of 1050
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? Lir1`S , y ` , Lv SIZOL GIP kL
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? On 5c� Od _SCja'
16. Why do you claim the City of Dubuque is responsible?�('O,�Jrd�
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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 U°e c, e ryi k cv- 20
(Signature)
Lr->'SS�x��
(Print Name)
Page 86 of 1050