Claim by Janet SmithCopyrighted
July 19, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Allison Lott for property damage; Janet Smith for property damage;
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Janet Smith Supporting Documentation
Claim by Allison Lott 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 Hail, 50 W.13'" St, Dubuque, IA 52001. 11
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 C
2. Address:
City: r ty: �u-r� State: Zip: S-d C' J/
3. Telephone Number. 4?- 6 :�- 41 S / -,k / 3 '7
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific): ewi,�
7. DESCRIBE ACCIDENT OR OCCURRENCE
full details upon which you base your claim.
employee's name.)
�1\\\\ �s�C�F(jP✓{ ���'C �(1%/%II/C. 6�C-y/�TjtllSGGil4,
THAT CAUSED INJURY OR DAMAGE. (Give
If a City employee was involved, give the
S. What were weather conditions like? "'.97.+�
0. Give name and address of any witnesses: - `V w'e 1"'V.
10. Did police investigate? (If so, ghee names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
12. Was
any damage done
to
property?
(If so, describe property and the
extent
of
damages.
damage-)
Attach estimates
of
damages
or describe basis for ascertaining
extent
of
N.J. Alma vumK aanUayaa uu you wormy a any r
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& amount do you claim from tl�e C"ty of Dubuque?
7`.. 4-2 z7 cs rr. oy �c /! fir
16. Why do youpaim the City 5f Du" Is responsible? -
17. Have you made any claim against anyone else for�damages as a result of this incident?
(If yes, give name and address.)
<Z4 110
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this day of , 20,2Z.
V 'I�IJC T t /" / %✓7 (Print Name)
(Rev. 5118)
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City of Dubuque
City Council Meeting
Consent Items # 3.
Copyrighted
July 19, 2021
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: Allison Lott for property damage; Janet Smith for
property damage; Michael and Jane Thorne for property damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description
I CAP Referral
Type
Supporting Documentation
THE CITY OF
DUB E N N D H a
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Roy D. Buol and
Members of the City Council
DATE: 7/7/2021
RE: Claim Against the City of Dubuque by Janet Smith
Claimant Date of Claim Date of Incident Nature of Claim
Janet Smith 7/6/2021 2/9/2021 Property Damage
This is a claim in which claimant alleges claimant's sidewalk was damaged due to a
watermain break.
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
Christopher Lester, Water Department Manager
Janet Smith
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 589-4113 / FAX (563) 583-1040 / EMAIL jmedinge@cityofdubuque.org