Claim by Sarah AnthoneyTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
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To: Mayor Roy D. Buol and
Members of the City Council
DATE: August 18, 2011
RE: Claim Against the City of Dubuque by Sarah Anthoney
Claimant Date of Claim Date of Loss Nature of Claim
Sarah Anthoney 08/16/11 07/15/11 Vehicle Damage
This is a claim in which claimant that a City of Dubuque bus struck claimant's parked
vehicle on Booth 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
Barbara Morck, Transit Manager
Sarah Anthoney
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
CLAIM AGAINST THE CITY OF DUBUQUE, I a' Q
�EiVED
This written report constitutes your claim against the City of Dubuque, 1pyvAint t 53
should complete this form in full and attach any additional information that"
supports your claim.
City OT OS'
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The claim must be filed with the City Glerk at City Hall, 50 West 13th St., Dubu4UO. 'A
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: 3 r4 k d}` -1-)brt.
2. Address: 57( et1i7Lrt/ 7
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3. Telephone Number
4. Date of Incident:
5. Time of Incident:
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6. Location of Incident (Be specific): �`
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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 mpl y 's name.)
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8. What< ,ere weather cond' ions •like?
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9. Give name and address of any witnesses:
10. Did police investigate? (f so, given es of officers.)
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