Claim by Shannon Brenner Copyrighted
June 1, 2026
City of Dubuque CONSENT ITEMS # 2.
City Council
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Shannon Brenner for Vehicle Damage; Ann Marie Schroeder
for Personal Injury; J&R Rental LLC for Property Damage;
Austin Bodenhofer for Property Damage
SUGGUESTED Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
1. Claim by Shannon Brenner
2. Claim by Ann Marie Schroeder
3. Claim by J&R Rental Inc Nicholas Kluesner
4. Claim by Austin Bodenhofer
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA �U�S�S`+I��c�
This written report constitutes your claim against the City of Dubuque, lowa. You should
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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 recommenda#ion.
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THE CITY O� DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR INILL NOT BE PAID.
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1. Name of Claimant: F `+��,��.�r�����,�'�� �'��.,�,.����.,.��..,.
2. Address: L��1��` �!�l���,..� '141 �.�
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City: State: �!� Zip: �'iil �`
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3. Telephone Number: ,��� � ,� ��J �,.��G; (��
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4. Date of Incider�t: ^� ��l,, �. ,���" �- �° �-- �-%
5. Time of Incident: - 1 ���
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6. Location o#Incident {Be specific): r �1 r�(����.�(��'' � - �J �.
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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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$. What were weather conditions like? ����� b (� ���F��'1�'� ����,�j,� �"�1� ��'������
9. Give name and address of any witnesses: .. ���`�\ , `��' � � �'1�
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10. Did police investigate? (If so, give names of ofi�cers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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Page 65 of 1000
12. Was any damage done to property? (If so, describe property and the extent of damages.
Attach estimates of damages or describe basis for ascertaining extent of damage.)
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13. What other damages do you claim, i#any? �� �� �; '�'
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14. Have you been compensated fior any part o�- all of your claim by any insurance company?
(If so, give name and address of insurance com�any and amount paid.) � - �
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15. What amour�t do you claim from the City of Dubuqu '
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1 Why�o� ou claim �e Cif ,of Dubu ue is responsible?
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17. Have you made any claim against anyone else for damages as a result o#this incident?
(If y.es, ive name an � dre s.) �; , ,
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18. If the answer to Question 17 is yes, have you received any payment from that source, and
if so, in wha# amount.
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Dated at Dubuque, lowa this� � day of ' ��� , 20_�
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ti, )IC� U$��������°� �f�. • ,�-�`}�,������;�1 (Print Name)
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(Rev. 9124) �wu�
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