Claim by Suzan TaliaferroCopyrighted
September 20, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Lisa Delaney for vehicle damage; Suzan Taliaferro for personal injury.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Lisa Delaney Supporting Documentation
Claim by Suzan Taliaferro Supporting Documentation
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.
I,
include
Social Security Number(s)
./ Medical/Health Information
Personnel/Disciplinary Information
hereby certify that the attached documents
Bank Account Information
Financial 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.
rczah O�t ro
Signature
it:z �2r
Date
MV
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA Fvl I CP_
This written report constitutes your claim against the City of Dubuque, Iowa. You sFlu�i vwrliC
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. 1311, 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:
2. Addre
City:
State: � v Zip: b
3. Telephone Number: lo-5 - 9 14 '"9-a 0/,
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full d ails upon which base y ur claim, _If C� fyeerwas involved, give the
employee's , nnaame. ►
so
8. What were
nditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
11. Was Z.1j"'"
one injured? �(if so, give names, addresses and extent of injuries). p ��r
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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.) ,
13. What other damages do you claim, if any?
11ur.�1_ /ild lS
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
V .v /i(. G�-/'Irj'c ,
16. Why do you claim
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17. Have you made ar
(If yes, give name and
agai
Dubuque?q //))
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ne else for damages as a result of this incident?
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount? a / ",. /
Dated at Dubuque, Iowa this day of 'l �irr� r�20�.
(Rev. 5/18)
(Signature)
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(Print Name) _ F-
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City of Dubuque
City Council Meeting
Consent Items # 3.
Copyrighted
September 20, 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: Lisa Delaney for vehicle damage; Suzan Taliaferro for
personal injury.
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: 9/16/2021
RE: Claim Against the City of Dubuque by Suzan Taliaferro
Claimant Date of Claim Date of Incident Nature of Claim
Suzan Taliaferro 9/7/2021 9/6/2021 Personal Injury
This is a claim in which claimant alleges claimant was injured after a trip -and -fall caused
by an uneven and broken sidewalk.
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
Gus Psihoyos, City Engineer
Suzan Taliaferro
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