Claim by Elizabeth KabelisTHE CITY OF
DUB
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
E MEMORANDUM
DATE: June 28, 2011
RE: Claim Against the City of Dubuque by Elizabeth Kabelis
Claimant Date of Claim Date of Loss Nature of Claim
Elizabeth Kabelis 06/24/11 06/20/11 Vehicle Damage
This is a claim in which claimant alleges that as she was driving on Central near 9th
Street past the parking garage which is currently being constructed, she drove over a
plastic object with a 2" long metal spike, which punctured her tire.
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
Tim Horsfield, Parking Systems Supervisor
Elizabeth Kabelis
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
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 ou as to whether yo cl im ill or will not be paid.
1. Name of Claimant: /i Z2 l r . a lc
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2. Address: I 7 Oiler,
3- 4'15/ - 64'17
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3. Telephone Number:
4. Date of Incident:
5. Time of Incident: q: (S prn.
6. Location of Incident (Be specific): on Cj f17 41 £ - 1 L 1 hG n'ejd
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.)
_ LAS AP/0V 404/71 i i/r / Z p as e4 & area 1,✓1y0
12a/ty jaray 13 be,f lad( line/' ot(
a l'I on1( ;n0 fll;se. 7b)- /MI s -fwd -{fie d slt';n m y fir.
8. What were weather conditions like? Sunny 80`
9. Give name and address of any witnesses: cl oaf j / zo'F 1317 Ohven 5 /-
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10. Did police investigate? (If so, give names of officers.)
VI i°S, of--; cer Siet✓ar,'- name ad- ; f; led an int,aer,I f /2
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.)
ties, +le 1ef f -nir' krr had (ol. pirift iier4.
long mehl .Sp;k'., (See 040
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13. What other damages do you claim, if any? ' `vnf
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.)
no
15. What amount do you claim from the City of Dubuque?
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16. Why do you claim the City of Dubuque is responsible? C I a/%II
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17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and
address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated this at day of ) 20 11 .
(Signature)
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(Print Name)
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