Claim by Dan and Beth KennedyCity of Dubuque
City Council
CONSENT ITEMS # 2.
Copyrighted
July 6, 2026
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Corinna Lawler for vehicle damage; Dan and Beth Kennedy
for property damage; Delora Belanger for property damage;
Jon Roth for property damage; Kolton Nadermann for vehicle
damage; Michael Knopf for vehicle damage; Michael Meyer
for property damage; Patricia Haigh for property damage;
Patricia James for vehicle damage; Robert and Elizabeth
Leibfried for property damage; Devin Ragan for vehicle
damage.
SUGGUESTED Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
1. Claim by Corinna Lawler
2. Claim by Dan and Beth Kennedy
3. Claim by Delora Belanger
4. Claim by Jon Roth
5. Claim by Kolton Nadermann
6. Claim by Michael Knopf
7. Claim by Michael Meyer
8. Claim by Patricia Haigh
9. Claim by Patricia James
10. Claim by Robert and Elizabeth Leibfried
11. Claim by Devin Regan
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MVM
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. 13th 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 6)t+h
WILLNOT BE PAID.
1. Name of Claimant: ` CkAlA
2. Address:
City: State: _ Zi I
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3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
Location of Incide
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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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8. What were weather conditions like?
9. Give name and address of any witnesses. V %.e —�14
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10. Did police investigate? If so give names A Pc rs.
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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.)
15. What amount_qo you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?L
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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.) A,,1' C)
18. If the answer to Question 17 is yes, have you received any payment from that source, and
if so, in what amount? A" � / I t+
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Dated at Dubuque, Iowa this day of
Signature)
Print Name)
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