Claim by Laura MerrittMasterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MEMORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: July 16, 2012
RE: Claim Against the City of Dubuque by Laura Merritt
Claimant Date of Claim Date of Loss Nature of Claim
Laura Merritt 07/13/12 06/28/12 Vehicle Damage
This is a claim in which claimant alleges that a City bus rear -ended claimant's vehicle
while claimant's son Dylan was driving the vehicle at the intersection of Jackson and
East 22nd 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
Barbara Morck, Transit Manager
Laura Merritt
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, 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. 13t" 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. /J
1. Name of Claimant: i (.1 L --u/j- 1 �-� ,LG2 i
2. Address: (oq,7 Loco-et/ <_) ihti &re
3. Telephone Number: 55 7-4239/
4. Date of Incident: 'w'/02
5. Time of Incident: JY • / i
6. Location of Incident (Be specific): aQ, J s7L- 7L f LJ& 71P,e45;
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? fail ri,7 di-14-ki
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.) '.S
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11. Was anyone injured? (If so, give names, addresses, and extent of ij juries)v
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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.)
13. What other damages do you claim, if any?
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.)
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15. What amount do you claim from the City of D bu ue?
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16. Why do you claim the City of Dubki ue is responsif�le?
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17. Have you made any claim against anyone else for damages
(If yes, give name and address.) \06)
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as a result of this incident?
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 y of
(Rev. 7/12)
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(Signature)
1-04-cum i/� ,1 `e iJE'2 (Print Name)