Claim by Heather FlohrCity of Dubuque
ITEM TITLE:
SUMMARY:
SUGGESTED DISPOSITION:
ATTACHMENTS:
Description
Claim by Heather Flohr
Claim by Nancy Gourley
Claim by Jo Ann Witterholt-Weigel
Copyrighted
May 18, 2020
Consent Items # 2.
Notice of Claims and Suits
Heather Flohr for vehicle damage, Nancy Gourley for
property damage, JoAnn Witterholt-Weigel for property
damage.
Suggested Disposition: Receive and File; Refer to City
Attorney
Type
Supporting Documentation
Supporting Documentation
Supporting Documentation
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 W. 13th 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
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: ,MPC c\b\i‘r
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City: State: I Zip: saeo
2. Address:
3. Telephone Number: 141 -365- 11
4. Date of Incident: 4 I5j3ao
5. Time of Incident: 2 e !
6. Location of Incident (Be specific): *Vie kD
515 N .At -VOA I,N qute, IA 5g_OOO
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.)
8. What were weather conditions like? lea( hii5 VW/ rtr+ f�f
9. Give name and address of any witnesses: Mile,
10. Did police investigate? (If so, give names of officers.) pke tf etifitcw
police pcf w s Gi l ed ,et.5e 4 D- [63517, -e' &de I ,ride ', .
11. Was anyone injured? (If so, give names, addresses, and 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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lbw -h) ea ci Pth1re P) (4an1 or my ai wiv (
13. What other damages do you claim, if any? ad1
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.)
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15. What amount do you claim from.the City of Dubuque?
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16. Why do you claim the Pity of Dubuque is resp nsible? 1
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
of of
Dated at Dubuque, Iowa this day of Mfg. , 20"
1etMJ2C k\(
Rev. 5/18ilk ft-U/103 4E20
(Signature)
(Print Name)
weIA
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 prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of
your receipt of these items and destroy the communication and any attachments
immediately. Further disclosure of this information may violate state and federal
restrictions.
Confidential information may include the following:
1) Social Security Number(s)
2) Medical/Health Information
3) Personnel/Disciplinary Information
4) Bank Account Information
5) Financial Information
6) Credit Card Numbers
If any documentation you desire to submit to the City of Dubuque contains any of the items above
this cover sheet must be attached directly to the confidential information and indicate the type of
information that is included.
, hereby certify that the attached documents
include the following protected information:
Social Security Number(s) Bank Account Information
Medical/Health Information Financial Information
Personnel/Disciplinary Information Credit Card Number(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 all precautions to
protect my information from unnecessary distribution.
plebl r
nature Date
Copyrighted
May 18, 2020
City of Dubuque Consent Items # 3.
ITEM TITLE: Disposition of Claims
SUMMARY: City Attorney advising that the following claims have been
referred to Public Entity Risk Services of Iowa, the agent
for the Iowa Communities Assurance Pool: Heather Flohr
for vehicle damage, Nancy Gourley for property damage,
and Jo Ann Witterholt-Weigel for property damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
I CAP Referrals Staff Memo
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MEMO
To: Mayor Roy D. Buol and
Members of the City Council
Dubuque
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AII•A®erica City
wArrxl+LCMCIr,oJ
' 1111'
2007.2012.2013
2017*2019
DATE: May 6, 2020
RE: Claim Against the City of Dubuque by Heather Flohr
Claimant Date of Claim Date of Loss Nature of Claim
Heather Flohr 05/06/20 04/25/20 Vehicle Damage
This is a claim in which claimant alleges that her vehicle which was stopped in front of
Kohls Department Store was struck by a City of Dubuque Jule bus..
This claim has been referred to the Iowa Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Russ Stecklein, Transportation Services Field Operations Supervisor
Heather Flohr
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