Claim by Mary SummersCopyrighted
October 18, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Jennifer Ney for personal injury; Michelle Spear for vehicle damage;
Mary Summers for property damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Jennifer Ney Supporting Documentation
Claim by Michelle Spear Supporting Documentation
Claim by Mary Summers Supporting Documentation
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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: CA�ti2C�OCi 7�11, , ,/l�z,,—Ii/.yl n eAS
2. Address: UP fSI
City: �2,)L,,Uc lid State: �b �\ Zip: S,-4cc
3. Telephone Number: 5 3 c
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific): 72 M EMnu) Ja/►y , S6�
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?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
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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. Attach estimates of damages or describe basis for ascertaining extent of
damage.)
13. What other damages do you claim, if any?Qpvv,
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?
16. Whv do you claim the C
Dubuque is responsibl
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17. Have you made any claim against aAyone else
(If yes, give name and address.)
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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?
Dated at Dubuque, Iowa this i day of (� TltC�
S
(Rev. 5/18)
20a 1.
Signature)
rint Name)
City of Dubuque
City Council Meeting
Consent Items # 3.
Copyrighted
October 18, 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: Jennifer Ney for personal injury; Michelle Spear for
vehicle damage; Mary Summers for property damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description
I CAP Referral
Type
Supporting Documentation
THE Cji&E
DN N D N a
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Roy D. Buol and
Members of the City Council
DATE: 10/6/2021
RE: Claim Against the City of Dubuque by Mary Summers
Claimant Date of Claim Date of Incident Nature of Claim
Mary Summers 10/3/2021 8/31/2021 Property Damage
This is a claim in which claimant alleges claimant's window at her home was broken due
to a piece of metal shattering the glass when a City employee was mowing grass close
by.
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
Stephen Fehsal, Park Division Manager
Mary Summers
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