Claim by Janet GrewTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: January 10, 2011
RE: Claim Against the City of Dubuque by Janet Grew
Claimant Date of Claim Date of Loss Nature of Claim
Janet Grew 01/03/11 08/06/10 Personal Injury
This is a claim in which claimant alleges that she tripped and fell over a concrete car
stop that had been moved into the traveled portion of the sidewalk near 11 & Bluff
Streets.
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
Janet Grew
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001 -6944
TELEPHONE (563) 583 -4113 / FAx (563) 583 -1040 / EMAIL tsteckle @cityofdubuque.org
i
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 West 13 St., Dubuque, IA 52001. It will then be referred to
the appropriate department for investigation and to the City Attorneys Office. 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: -/� LT V `-� R £ W
- 2. Address: l 5 KA b4 141 A N N 141; E. hpt 3a
3. Telephone Number: L.5 3 - to 4 3 - 6-6L3
4. Date of Incident: Alga V-- / 0
5. Time of Incident: � Z, I ,V A
6. Location of Incident (Be specific): 11 t11 ' 61 r r
c5'cit, Lo h / feQ Pork) net 1 6 fe necir brain y
7. Describe the 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.)
� ! & e r n lent h I o C k U S e c "h 7T U p car 6
was HCRos dexa II\
i pp eel Fc. 1r.
8. What were weather conditions like? EX C e i )'e n
9. Give name and address of any witnesses:
wrL/
10. Did police investigate? (If so, give names of officers.)
E s - De N KnO NA m o o
11. Was anyone injured? (If so, give names, addresses, and extent of injuries.)
y e s JCtntr V' 3)4 ��- g I
O/oQd /VD 5& - 5 c ropt `� �' bru �' c Frz i An 6es f'v toTe_h Ci
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.)
1\)0
DUBUQUE FIRE EMS
($00)786 -4911 Ext. 230
Patierr Name: JANET GREW
#BWNKMRY
JANET GREW
2955 KAUFFMAN AVE APT 321
DUBUQUE, IA 52001
DESCRIPTION OF CHARGES
BLS EMERGENCY BASE RATE -RES
MILEAGE RESIDENT
Patient Name: GREW, JANET V
DUBUQUE FIRE EMS
C/O LIFEQUEST BILLING OFFICE
N2E/30 STATE ROAD 22
WAUTOMA, WI 54982 -5267
HCPC
A0429
A0425
QUANTITY
1.0
1.0
Federal Tax ID: 42 6004596
Call Number:
Date Of Call:
Call Time:
From Location:
To Location:
Reason(s) 869.1
For
Transport
Insurance:
UNIT PRICE
500.00
10.00
Total Charges 510.00
This collection agency is licensed by the: Total Credits 0.00
Office of the Administrator of the Division of Banking
P.O. Box 7876, Madison, Wisconsin 53707
TOTAL AMOUNT DUE _>
"DETACH ALONG ABOVE LINE AND RETURN STUB WITH YOUR PAYMENT^
Thank you for using our ambulance service. Accounts not covered by
insurance are to be PAID IN FULL WITHIN 30 DAYS OF BILLING.
Call Number: 30 -10 -3154
Billing Date: 08/27/2010
30 -10 -3154 PP do
08/06/2010
12:45 PM
W11TH ST & BLUFF ST
FINLEY HOSPITAL
Total Amount Due: $510.00
Amount Enclosed: $
Visit our website at www.myambulancebill.com
AMOUNT
500.00
10.00
$510.00
Service ID: AMB30
Side 2 of 2
We are required under State law to notify consumers of the following rights. This list does not include
a complete list of rights consumers have under State and Federal laws.
This is an attempt to collect a debt by a debt collector and any information will be used for that
purpose.
** *ADDITIONAL INFORMATION FOR CALIFORNIA RESIDENTS * **
The state Rosenthal Fair Debt Collection Practices Act and the federal Fair Debt Collection Practices Act
require that, except under unusual circumstances, collectors may not contact you before 8 a.m. or after
9 p.m. They may not harass you by using threats of violence or arrest or by using obscene language.
Collectors may not use false or misleading statements or call you at work if they know or have reason
to know that you may not receive personal calls at work. For the most part, collectors may not tell
another person, other than your attorney or spouse, about your debt. Collectors may contact another
person to confirm your location or enforce a judgment. For more information about debt collection
activities, you may contact the Federal Trade Commission at 1- 877 - FTC -HELP or www.ftc.gov.
Nonprofit credit counseling services may be available in your area.
** *ADDITIONAL INFORMATION FOR COLORADO RESIDENTS * **
FOR INFORMATION ABOUT THE COLORADO FAIR DEBT COLLECTION PRACTICES ACT,
SEE WWW. AGO .STATE.CO.US /CADC /CADCMAIN.CFM. A consumer has the right to request
in writing that a debt collector or collection agency cease further communication with the consumer.
A written request to cease communication will not prohibit the debt collector or collection agency
from taking any other action authorized by law to collect the debt.
** *ADDITIONAL INFORMATION FOR MINNESOTA RESIDENTS * **
This collection agency holds a licensing exemption by the State of Minnesota
Department of Commerce.
Our office hours are Monday- Thursday 9a.m.- 9p.m., Friday 9a.m.- 5:30p.m. and Saturday
9a.m. -lp.m. CDT Should you have any questions regarding your account, please contact
our office below:
c/o LifeQuest
N2930 State Road 22
Wautoma, WI 54982
(877)663 -3729