Claim by Carolyn LeuteMasterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: April 20, 2011
MEMORANDUM
RE: Claim Against the City of Dubuque by Carolyn Leute, represented by
Attorney Todd Klapatauskas
Claimant Date of Claim Date of Loss Nature of Claim
Carolyn Leute 04/19/11 01/28/11 Personal Injury
This is a claim in which claimant alleges that as she was walking in the Iowa Street
Parking Ramp she was struck by a vehicle driven by an off -duty police officer.
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
Terry Tobin, Acting Police Chief
Todd Klapatauskas, Esq.
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
/ . % (2 4 )
,
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 Attorney's 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: Carolyn J. Leute
2. Address:
3. Telephone Number h - 563 556 - 0865 c 563 542 - 8690
4. Date of Incident:
5. Time of Incident:
120 Cherokee Drive, Dubuque, IA 52003
01 -28 -11
10:15 a.m.
6. Location of Incident (Be specific):
Iowa Street Parking Ramp
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.)
I was walking in the parking ramp headed from my parked car to work.
I was hit by the vehicle being driven by Scott Baxter.
8. What were weather conditions like?
Inside the parking ramp
9. Give name and address of any witnesses:
None known
10. Did police investigate? (If so, give names of officers.)
Officer Sabers - Badge ,$60
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Carolyn J. Leute, 120 Cherokee, Dubuque, IA 52003
Extent and severity not known at this time.
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.)
None.
13. What other damages do you claim, if any?
Physical Injuries
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.)
My BlueCross /Blue Shield has been making payments on these bills.
My insurance company, State Farm, has been making med pay to BlueCross /Blue Shield.
15. What amount do you claim from the City of Dubuque?
Not known at this time.
16. Why do you claim the City of Dubuque is responsible?
Unsafe conditions
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes, give name and address.)
I may against Scott Baxter.
18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
No.
/
Dated this I Z day of
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Carolyn J. Leute
(Print Name)
April
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