Claim by Emily Treanor Copyrighted
February 17, 2020
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Linda Lucy for property damage, Emily Treanor for property
replacement, United States Postal Service for property
damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City
Attorney
ATTACHMENTS:
Description Type
Claim by Linda Lucy Supporting Documentation
Claim by Eleanor Treanor Supporting Documentation
Claim by USPS Supporting Documentation
s �� �� �
� � � ����� � �
,
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ��,���� ��KS
This written report constitutes your claim against the City of Dubuque, lowa. 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 W. 13th St., Dubuque, IA 52001. It �
will then be referred by the City Council to the appropriate department for investigation. !l
Once that investigation is completed, a report and recommendation will be submitted to the II,
City Council. You will be provided with a copy of that report and recommendation. y
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF '
�
THE CITY OF DUBUQUE HAS THE AUTHORITY �'O MAKE ANY REPRESENTATION TO YOU '�
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. ;
`
1. Name of Claimant: ��1 � �����1� � I�
` � � l �� �` � �
..
2. Address: � �
��� �
City: �/��� � �� State: � Zip: C��� � � '�
3. Tele hone Number: ��� �i
p l�
�
;
4. Date of Incident: I�
i
�
5. Time of Incident: J {u
- � I;
6. Location of Incident (Be specific): `� l � � �� � I � i
�
I
;
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OFZ DAMAGE. (Give �
full details upon which you base your claim. If a City employee was involved, give the �
employee's name.)
� , ����c� Ca� � �� �� �l �� ?�� c� ����
��� ��, � �� � � � �'� � �� 'rv1 �- `I'!�' ��� � J� � JG� ,
� �a� ':
�a VVh�#�er� �e�ther� �cr�dE#i�r�� iik�? � ��
9. Give name and address of any witnesses: ��
10. Did police investigate? (If so, give names of officers.)
,I`��
,
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
� �
I
I
'�I
�
'I
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.) i
� LI� - b� � � � � � ��S �� c� C� � � � � �a
.;
},
a
a
4
13. What other damages do you claim, if any? ;
�
�
�
I
;
'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.) i
� � �a
�
15. What amount do you ctaim from t1�e�C�ity�o�ubuque? i�
`l l� �i
16. Why do ou claim th City o Du u e 's r sponsible? a '�
�� �r1�. �n `� � c� � � �� C�' (���� ��1 cS�.�c� ��J� �'L'� �
� : � � � , c�, �' � 1 � �
,� U�J �� . � C, c. � C� 1 ,�
17. Have you made any claim against anyone else for damages as a result of this incident? 4� �
(If yes, give name and address.) �\ )GI J1��u�(
� t.,�
. ��"��5�
18. If the answer to Question 17 is yes, have you received any payment from that source, ���� ��
and if so, in what amount? ,/�� Cy�f� �
VI
� � �'� � ,
Dated at Dubuque, lowa this day �f �� � , 20�-(� �
)
�gig�ai�r�j
� VI� � ;�� � �� �? �
(Print Name) ���- �"r �
�� �; � �
,.�� � .._._
� �; � �
c�
� � �
� � �
� � � �
�� C.J
(Rev. 5/18) : f �
�
I
�
i
Confidential
This communication and any attachments may contain information which is confidential �
and privileged by law and is for the use of the designated recipient. If you are not the �
intended recipient, you are hereby notified that you have received this communication in '�
error, and that any review, disclosure, dissemination, distribution or copying of its contents
is rohibited. Please notif Cit of Dubu ue immediatel b tele hone at 563 -589-4120 of ��
p Y Y q Y Y p � ) ,j
your receipt of these items and destroy the communication and any attachments
immediately. Further disclosure of this information may violate state and federal I��
restrictions.
h
V�
I���
Confidential information may include the following: i��
'�1
1) Social Security Number(s) �
2) Medical/Health Information �
3) Personnel/Disciplinary Information ;,
4) Bank Acc�urt lnf�rmatior, `�I
5) Financiallnformation �
6) Credit Card Numbers ''�,�
;
;
If any documentation you desire to submit to the City of Dubuque contains any of the items above 'i
this cover sheet must be attached directly to the confidential information and indicate the type of �'�
information that is included. '
y
;�;
F. i�
I{
I, � � � �� �� , hereby certify that the attached documents �j�
include the following protected information: I;
�i
i,
Social Security Number(s) Bank Account Information � '�
Medical/Health Information Financial Information
� �
Per�onne!/D'o�ciplorary Inforrration Cre��t Card �Jumber(s) �
I understand that this information may be distributed within the City organization or to agents of the �
City for processing and I hereby authorize the City to act accordingly taking ail precautions to a
pr�tect ���y i�fo���aiicn ir�rn u�n�c��sary distribuiion.
�
1� 2 � �-C�
Signature Date � �