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Claim by Noreen Engelken 02-13-09THE CITY OF DUB E MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: RE: Claimant February 17, 2009 Claim Against the City of Dubuque by the Noreen M. Engelken Date of Claim Noreen Engelken 02/13/09 Date of Loss 01 /26/09 Nature of Claim Personal Injury This is a claim in which claimant alleges that she tripped on an icy uneven portion of walkway between the NICC Buildings located in the Town Clock Center and injured herself. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. BAL:tIs cc: Michael C. Van Milligen, City Manager Tim Horsfield, Parking Systems Supervisor Gus Psihoyos, City Engineer Noreen Engelken 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 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 West 13"' 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. Name of 2. Address: Claimant: ' k. f, r ~-h .~ S ~ o ~5 3. Telephone Number: ``~~ 3 `~~ a ~~f / `~ 4. Date of Incident: ~J A/1l ~ ar U c~ ~o . oZUU C.~ 5. Time of Incident: ~ • ~ D ~ M 6. Location of Incident (Be specific): f r~ ~ aw 7th ~'f'YQQ T ~ix~ IA1~1.1 ~tt 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 emplloyee's name.) 1. ~, 1 ~ ~ l ~ ~(,i A Q ~M `~-`t1t .Df~-(l. K.!~_r' e~.M.p h o ~~t.~~ ~e r l ~-~-{'le N ~ C~. 1~ w ~ ~v~c~.$ ©n `~'S>_i W~,j.~s.«Y~u . •~hba~, rv<~ r~'u ~~ ~can-r', t°~ (~f a-{te r~~Scnl C'e.r-~Q.n-f , ~~.G~ ~~~~~r~} i,uh~ l~- ~.,~.., Il,~ ~- L.eg . J ' 8. What were weather conditions like? ~(71C7 // Qd.d~ .S/ ni1N r '/ . 9. Give name and address of any witnesses: ~),~K_!?, . ~ /.l!0rl ~r ~y~ /1/l~ ices 'Q ~ n a r~ l/T,ri`LLy+" ~ld n n ~,v` a MGM ~ lti o w 10. Did police investigate? (If so, give names of officers.) ~lo~c~;~flh~~r~ IJ~Anrle.-rU L'~S~'~ 09~ 37~'% 11. Was anyone injured? (If so, give names, addresses, and extent of injuries.) ~drn P -~ ~naeJ ~r Pm - ~`n ~ L~ ~ f ~wc.~r b ~-~~~ _~ /~T ~-~d r,`~ hf ~e~ - 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.) 13. What other damages do yo/u claim, if any? ~Q~iGlt ~ C1 % ~~5 %r~~1JPC'c~%`G n>L~ /Yi~~/, L~iic~~ Cled/ ~he%~.~cu~, c, 14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give name and ad~drPess of insurance company and amount paid.) 15. What amount do you claim from the City of Dubuque? ~i'1~? ~P ~/YI ~ ~17e~ - pC~Y1C~~ r` /I C{ ~,~ Q ~St: -tau, 16. Why do you claim the City of Dubuque is responsible? /~~. ~/~~~ L ~~S 2`~ Q,. /)~ y ~) ~n~'r~ ~ l `~luPr~ u~'r+5 ~-r; ht~fed -~o -~~ e. 17. Have you made any claim against anyone 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 so, in what amount? Dated this f~ f~ day of ~~r/.cc2 r~;~ , 20G~ 9 a (Signature) (Print Name) ~'~P1 cs Ce~~~~,~s c~ n ~~ rn ~ C r` C33 _ ']'I ~`" W ~ ~ :~J ~ '-`gory - i~1 _ ..J _. ~ ~' CD ~