Claim by Donna Amy Kuhlman Copyrighted
June 17, 2019
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Donna Kuhlman for vehicle damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City
Attorney
ATTACHMENTS:
Description Type
Claim by Donna Kuhlman Supporting Documentation
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Park�CLAIM AGAINST THE CIN OF DUBUQUE, IOWA
This wriHen repart constl[u[es your elalm against the Cily of �ubuque, lowa. You should �
complete [his form in full antl attach any atltllllonal inPormatlon fiat supports yourclaim. �
The Claim must be filed with ihe Ciry Clerk al City Hall, 50 W. 15'^ 5[., Oubuque, IA 5Y001. It �'
wlll then be referted by [he City Council to iM1e appropria[e tlepartmen[ for ImesOgatlon. '�,
Once thal investigation is completetl, a report and recommentla[ion will be submiHetl to lhe '.
ptyCouncil. YouwillbeprovitletlwitM1acopyoftha[ reportantlrecommenda[ion. '
THE FINAL �ECISION ON ALL CLAIMS IS MA�E 6Y THE CITY COUNCIL. NO EMPLOYEE OF -
THE CITY OF OUBUQUE HFS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOII ,
AS TO WHETHER VOUR CLpIM WILL O/R WILL NOT1/BE P�A��IU�.�n I
1. NameofClaim�van,l:�\ �✓�, 'V\O. J`\rn�( '�Ip.�tt(J✓ ��� �,
2. Adtlress:�ll"i 1�11�3A2- ��-(�V� Cn�� ..
City: �Slao[en: e�[�tt _ Zip: �
3. TelephoneNumbe�I _ /�� -� Jl 1- 12 � �
4. Oateoflncitlent: ��-1� - (�`-C' ��I�
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5. Time of IncidenL i
6. lo ti of Incltl t (Be specific�: �
�c� �_��
]. DESCRIBE ACCIOENT OR OCCl1RRENGE THAT CAUSE� INJURY OR ppMAGE. (Give �
full details upon which yau base your clalm. If a City amplayee was involveq give iM1e
employee's name.) _
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B. WM1atwereweaiherconditionslike9C� �� � �-�VU � V��
9. Give name antl atltlress otany witnes�� ��/h0 �.
t0.� Ditl police imesliga[e? (It so, gNe names of offirersJ , (�� ��.
`N�-2> � f� �ntiDlow,t �..a,n b�.Q�r�! @ .�r ,
11. `W�asn a�nyane In7ured? Qf so, give names, addresses, antl 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 yo�ar claim by any insurance
company? (If so, give name and address of insurance company and amount paid.) '
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15. What amotant do you claim from the City of Dubuque?� � �� o ��
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16. Why do you claim the City of Dubuque is resportsible?� � � � ��
'�7, Have you made any claim against anyone else for damages as a resu[t of this incident?
(If yes, give name and address.} �
18. If the answer to Question '�7 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, lowa this � day of , 20�.
(Signature)
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Copyrighted
June 17, 2019
City of Dubuque Consent Items # 3.
ITEM TITLE: Disposition of Claims
SUMMARY: CityAttorney advising that the following claims have been
referred to Public Entity Risk Services of lowa, the agent
for the lowa Communities Assurance Pool: Donna Amy
Kuhlman for vehicle damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referral Staff Memo
THE CTTY(�F ���.
�U8 � E MEMORANDUM
Masterpiece on the Mississippi
� �AC €Y �Y€ � nL € � tl'
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council '
�
DATE: June 10, 2019 �
1
RE: Ciaim Against the City of Dubuque by Donna Amy Kuhiman �
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Clairr�ant Date of Claim Date of Loss Nature of Claim �
Donna Am Kuhlman 06/07/19 06/04/19 Vehicle Dama e �
Y 9 �
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This is a claim in which c6aimant alleges that the crossing gate arm at the Locust Street �
Parking Ramp malfunctioned when it lowered and struck claimant's vehicle �
This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa �
Communities Assurance PooL
cc: Michael C. Van Milligen, City Manager �
Russ Stecklein, Transportation Services Field Supervisor
Donna Amy Kuhlman
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OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TE�EPHONE (563)583-4113/FAx (563)583-1040/EMa�� tsteckle@cityofdubuque.org