Claim by Shanita Alexander THE CITY OF
DUBE MEMORANDUM
Masterpiece on the.Mississippi
TRACEY STECKLEIN lip
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: March 13, 2015
RE: Claim Against the City of Dubuque by Shanita Alexander 7
Claimant Date of Claim Date of Loss Nature of Claim
Shanita Alexander 03/12/15 03/02/15 Vehicle Damage
This is a claim in which claimant alleges that a Parking Meter Attendant driving a City
vehicle entered E. 9t" Street from a parked position and struck claimant's vehicle.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool
cc: Michael C. Van Milligen, City Manager j
Tim Horsfield, Parking Systems Supervisor a
Shanita Alexander j
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OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563)583-4113/FAx (563)583-1040/EMAIL tsteckle@cityofdubuque.org
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03/12/2015 12:50 15632 130253 H'YVEE PAGE 01 .,6'L
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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This written report constitutes your claim against the City of Dubuque, Iowa. You should f
.complete this form in full and attach any additional Information that supports your claim.
The Maim 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 MANCE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE RAID.
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1. Name of Claimant:
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2, Address:
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3. Telephone Number:
4. Data of Incident:
5. Time of Incident: }` �`�� 0,Y)
6. Location of Incident (Be specific): ���� �� AreP4 w"OA
Log, �
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7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give i
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? .. a
9. Give name and address of any witnesses: 9kyvA)LI, 2,711- 1), 1
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10. Did police investigate? (If o, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of Injuries).
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03x'1212015 12:50 15632430253 HYVEE PAGE 02
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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? ; JOU
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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?
16. Why do y u FjaIM the City of Du uque is responsible?
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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.) 1/}y
18. If the answer to Question 17 is yes, have you received any payment from that source,
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and if so, in what amount?
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Dated at Dubuque, Iowa this ,L day of 20_/�' .
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(Signature)
.� (Print Name)
(Rev. 7112) or M
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