Claim by Joshua HolderCopyrighted
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. 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.
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Name of Claimmnant: JOS�JCn � Mt-im i-�O e--
2. Address: d 0 � -I F I Wl 4
City: I 1 if-yq/v�e State
3. Telephone Number: I sq< qlq
4. Date of Incident: (iA. IS., ot0 ).1
5. Time of Incident: `j� q : aS Qm
6. Location of Incident (Be specific):
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Zip: 5aodl
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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.)
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8. What were weather conditions like? 610LJJN . ' bj-(?T 42ayWe4
9. Give name and address of any witnesses: rVA
10. Did police investigates? (If s�o,ggive 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. Attach estimates of damages or describe basis for ascertaining extent of
damage.)
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13. What other damages do you claim, if any? 11A
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. Vyhat amount do you claim from the City of Dubuque?
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16. Why do; you claim the Citypf Dubuque 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.)
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
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Dated at Dubuque, Iowa this r day of 6j. 20-4.
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(Rev. 5/18)
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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.
include the following protected information:
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.
Signature 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 /24/2021
RE: Claim Against the City of Dubuque by Joshua Holder
Claimant Date of Claim Date of Incident Nature of Claim
Joshua Holder 10/29/2021 10/29/2021 Vehicle Damage
This is a claim in which claimant alleges claimant's vehicle was damaged due to Claimant
hitting a raised water valve cover sticking out of a City street.
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
Joshua Holder
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