Loading...
Claim by Devin Regan Copyrighted May 4, 2026 City of Dubuque CONSENT ITEMS # 2. City Council ITEM TITLE: Notice of Claims and Suits SUMMARY: Devin Rogan for Vehicle Damage; SUGGUESTED Receive and File; Refer to City Attorney DISPOSITION: ATTACHMENTS: 1. Claim by Devin Regan Page 95 of 668 �nv� %�c� CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ��ti-Y,��j��,��-, This written report constitutes your claim against the City of Dubuque, lowa. You should cornplete 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: '�j �L,`�/�j,�,�� �, City: �,� � State: �G�a�_ Zip: _���� 3. Telephone Number: ���� ����-�j��L/ 4. Date of Incident: _�j' �'3D/�� 5. Time of Incident: ��� �G 6. Location of Incident (Be specific): Ofil .,L ,� �✓�,-��--- o,,G J-�'`�` _ � .�'tiL��� 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.) ..� /.�?3 �r.��� ������ip�- ` �� -�,r � -� e ( ` I� G� `�-�,-�' 1i�j;c�� .�� Q'���� �A '�c� ��-�- 5'�Q�C' � �� �lr 8. What were weat er conditions e? �� � 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) Y�j 10r/� � �� �- �i���l�--- ��,�- ���.Ps' �-�'��-n ���'� �� �s � 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). 5���� ��� ��/ Page 96 of 668 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.) �/C"�7 � �� �{ ����G'�/P �vl j�� � ��i� � . 13. What other damages do you claim, if any? 14. Have you been compensated for any parfi or all of your claim by any insurance company? (If so, give name and address of insurance company and amount paid.) J�� 15. What amount do you claim from the City of Dubuque? =r ��S G-�,���� � 16. Why do you claim the City of Dubuque is responsible? a � � 1��e you�e any�c�lai�ai�ny6ne 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 s����hat amount? �� Dated at Dubuque, lowa this ��`day of��/� , 24�. � —" (Signature) . , (Print Name) .. � :N � . ; .' , .,,� �,, . (Rev. 9/24) .. . � ,; ., ,�., .....�..,. . �.� : ,r ��,M. °� ,., Page 97 of 668