Loading...
Claim by Dorothy L. LesterTHE CITY OF DUB E MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL --o To: Mayor Roy D. Buol and Members of the City Council DATE: February 11, 2010 RE: Claim Against the City of Dubuque by Dorothy L. Lester Claimant Date of Claim Date of Loss Nature of Claim Dorothy L. Lester 02/09/10 07/30/09 Personal Injury This is a claim in which claimant alleges that she was injured while attempting to exit a City of Dubuque Keyline bus in front of 1199 Main Street. 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 Dave Heiar, Economic Development Director Dorothy L. Lester 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. 1. Name of Claimant: Dorothy L. Lester 2. Address: 793 1/2 Clarke Drive, Dubuque, Iowa 52001 3. Telephone Number 563 - 582 - 6340 4. Date of Incident: July 30. 2009 5. Time of Incident: 10:20 A.M. 6. Location of Incident (Be specific): 1199 Main Street, Dubuque. Iowa near St. Lukes Church 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.) I fell exitin ci bus #2565. The bus was having some .r. . -lm . hi h n• front of the bus to lower. I stepped off thinking that the his was closer to the club as it usually is) that it was. 8. What were weather conditions like? No. 9. Give name and address of any witnesses: James M Gianta - hug driver 10. Did police investigate? (If so, give names of officers.) No. 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). Yes, Dorothy L. Lester 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.) No 13. What other damages do you claim, if any? Broken shoulder 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.) No 15. What amount do you claim from the City of Dubuque? Ambulence bill $520.00; medicals - unknown to date -will supplement this claim when received; ManorCare - unknownto date - will supplement this claim whep received 16. Why do you claim the City of Dubuque is responsible? I ride the buses frequently, and this time, when I stepped off, the elevation was different from usual becuase the bu n. nin 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) No 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? lJ Dated this ‘, day of Sr A/00 6& �I � , 20 09 . `� n I 4t.,-7 o P.� ��Z C. u j j ' - Z. (Signature) o N Q Dorothy L. Lester 7, N (Print Name)