Claim by Caitlyn TekippeCopyrighted
December 6, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Phyllis Hankel for personal injury; Joshua Holder for vehicle damage;
Scott Kress for property damage; Caitlyn Tekippe for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Phyllis Hankel Supporting Documentation
Claim by Joshua Holder Supporting Documentation
Claim by Scott Kress Supporting Documentation
Claim by Caitlyn Tekippe Supporting Documentation
CLAIM AGAINST THE CITY OF DUBUQUE. IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. YoAsho
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
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant:
2. Address:
City: � -ockc
3. Telephone Number:
State: Zip: �(U
=- (� �- 3a5 y
4. Date of Incident: lblk cyc VD , dam' LA
5. Time of Incident:
6. Location of Incident (Be specific):
on
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.)
r\acc�S ca/ c�- g i w\W&& O
110A �V�kD -Po C- rcc,�Tw� 2kz ° J-(r-
I
8. What were weather conditions like? S V �A A �
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
/ )b
11. aVW� as anyone injured? (If so, give names, addresses, and extent of injuries).
/ CC)
12. Was anv damage done to propertv? (If so, describe propertv and the extent of
damaaes. Attach estimates of damages or describe basis for ascertaining extent of
damage.)
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.)
A)O
15. What amount do you claim from the City of Dubuque?
�a 4 q-._ 0
16. Why do you claim the City of Dubuque is responsible? �
inn s (o a�� l n ct v� �� L, C%��nn L!��L YA 1yIf �n i c tL
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) ,l I 0
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 N oy v�b-W 20.
(Signature)
VA\ Print Name) o
.c n-
n N
(Rev.5118) m r13
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)-5894120 of
your receipt of these items and destroy the communication and any attachments
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
information that is included.
i. hereby certify that the attached documents
the folWwing protected
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 fror"necessary distribution.
re Date
City of Dubuque
City Council Meeting
Consent Items # 3.
Copyrighted
December 6, 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: Anthony Cobbins for vehicle damage; Phyllis Hankel for
personal injury; Joshua Holder for vehicle damage; Scott Kress for
property damage; Caitlyn Tekippe for vehicle damage; White Animal
Hospital 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: 11 /17/2021
RE: Claim Against the City of Dubuque by Caitlyn Tekippe
Claimant Date of Claim Date of Incident Nature of Claim
Caitlyn Tekippe 11 /16/2021 11 /10/2021 Vehicle Damage
This is a claim in which claimant alleges claimant's vehicle was damaged when the gate
in a City parking ramp came down in the vehicle's roof.
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
Russ Stecklein, Interim Director of Dubuque Transportation Services
Caitlyn Tekippe
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