Claim by Timothy Kelly Copyrighted
August 7, 2017
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Alec Benson for vehicle damage, Lester& Susan Bettcher
for property damage, Linda Breitbach for personal injury,
Charles and Ruth Ellis for property damage, Timothy Kelly
for vehicle damage, Mark Lansing for vehicle damage,
Monique Hopkins for vehicle damage, Aislinn O'Brien for
vehicle damage, Lynn Pollock for vehicle damage, suit by
Chris Cullen for Civil Service veteran's points application.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City
Attorney
ATTACHMENTS:
Description Type
Benson Claim Supporting Documentation
Bettcher Claim Supporting Documentation
Breitbach Claim Supporting Documentation
Ellis Claim Supporting Documentation
Hopkins Claim Supporting Documentation
Kelly Claim Supporting Documentation
Lansing Claim Supporting Documentation
O'Brien Claim Supporting Documentation
Pollock Claim Supporting Documentation
Cullen Suit Supporting Documentation
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA Pa1t
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This written report constitutes your claim against the City of Dubuque, Iowa. You �YIC
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 West 13th St.,
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. 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.
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1. Name of Claimant: [
2. Address: al Ci (ice , �� s 00a,
3. Telephone Number SG - 5q4- 3: S 7
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific): y n �^
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7. Describe the 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/? &,c- k-J 1 p"sk-d 0&00. cte,-
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9. Give name and address of any witnesses:
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10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.)
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15. What amount do you claim from the City of Dubuque?
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16. Why do you claim the City of Dubuque is responsible?
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17. Have you made any claim against anyone else for damages as a result of . ,� rfi eau
this incident? (If yes, give name and address.)
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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 what amount?
Dated this 7 day of , 20_Q ' -
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(Signature) -£
(Print Name) CD
Copyrighted
August 7, 2017
City of Dubuque Consent Items # 3.
ITEM TITLE: Disposition of Claims
SUMMARY: City Attorney advising that the following claims have been
referred to Public Entity Risk Services of Iowa, the agent
for the Iowa Communities Assurance Pool: Lester and
Susan Bettcher for property damage, Linda Breitbach for
personal injury, Ruth Ellis for property damage, Monique
Hopkins for vehicle damage, Timothy Kelly for vehicle
damage, Mark Lansing for vehicle damage, Aislinn O'Brien
for vehicle damage, Lynn Pollock for vehicle damage, suit
by Chris Cullen for Civil Service veteran's points
application.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Supporting Documentation
PERS Referral - Cullen Suit Supporting Documentation
THE CITY OF .
DUB -, E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: July 31, 2017
RE: Claim Against the City of Dubuque by Timothy Kelly
Claimant Date of Claim Date of Loss Nature of Claim
Timothy Kelly 07/27/17 07/21/17 Vehicle Damage
This is a claim in which claimant alleges that due to heavy rains and because there was
no signage posted warning of high water, claimant's vehicle became partially
submerged while he was driving near the intersection of Rosemont Street and Hillcrest
Avenue.
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
John Klostermann, Public Works Director
Timothy Kelly
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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