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Claim by Nancy Fett Copyrighted December 16, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Nancy Fettforvehicle damage; Lawrence Hutton, Jr. for vehicle damage; Jonathan Kueter for vehicle damage; Michael Nagelmaker for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Claim by Nancy Fett Supporting Documentation Claim by Lawrence Hutton, Jr. Supporting Documentation Claim by John Kueter Supporting Documentation Claim by Michael Nagelmaker Supporting Documentation � �� , u CLAIM AGAINST THE CITY OF DU�UQUE, IOWA �-�� ;� 1�a.�5i�- �2��C� �- � This written report constitutes your claim against the City of Dubuque, lowa. You should it,��1 I� complete this form in full and attach any additional information that supports your claim. ��a-� � ��- -s�� i; The Claim must be filed with the City Clerk at City Hall, 50 W. 13t" 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 �i �� 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 Ii AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. ' I, �i 1. Name o# Claimant: �G�'1,��L.. �, ��' � II r �� 1 ;' 2. Address: 5�� 1�t,��,ts S'�,� ``�.]�.,�+ ji � City; w�� State: (-� Zip: ��' �� 3. Telephone Number: ��-�- ��'7 ��—��7�'�� ) � �� g �� 4. Date of Incident: �'1-- �-- P 1 �a I 5. Time of Incident: � Q �� .rr� ; ;� 6. Location of Incident (Be specific): �''��'� ll��s�� - �'�.�� h 1 i� 7. DESCRIBE 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��l�.xr�,r�'7� '�,d V15�L�s� 1/�P..,�.t.�°�.�C� .�Zl� �.,t�� -- C.�..,�P"` -- � � � � � 8. What were weather conditions like? �� .�l i �- � � 9. Give name and address of any witnesses: � 10. Did police investigate? (If so, give names of officers.) � � �� e� l�r��,c� � �� 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � �1� ..�— � � F � � � , 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.) � �t� s--� �-F� �a� -- �a��'km��r`�a� G1�t��.-�_ �i �! � � � ,I � 13. What other damages do you claim, if any? ' ,; ,, �� ,,I �, i� li 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.) '' � �� ;� 15. What amount do you claim from the City of Dubuque? ; �y,, �,.��•�, � 4. �� 1�°`W"'1 � f � J °u , �� .A�.�� t" � 4�! � � .Q f� �� 1.��.' �� 16. Why do you claim the City of Dubuque is responsible? I'''� ; i e�a��-� �a�. v��re,l�.. �- ��- �� A.s ,�,� �� , p ;i 17. Have you made any claim against anyone else for damages as a result of this incident? '� (If yes, give name and address.) ' �'1� ; 18. If the answer to Question 17 is yes, have you received any payment from that source, ;�� and if so, in what amount? �� Iq �l Da#ed at Dubuque, lowa thi� �-� clay of �C7'1,� , 20�. � � � � �.�. � / � (Signature) � __, � €� �,_ �,�} � "� IT�``�= �� ::�� f 1(�,�I'�l ,G�t ��A"" ��.-� (Print Name) �- c�r= � I�� r:_" CL � �""`" s..7 �- F.�,�.� � � � � � �� - � � CL? "'"� t�+ (Rev. 5/18) � � , � e � �