Claim by Jennifer SheldonMasterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MEMORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: July 18, 2012
RE: Claim Against the City of Dubuque by Jennifer Sheldon
Claimant Date of Claim Date of Loss Nature of Claim
Jennifer Sheldon 07/17/12 07/12/12 Property Damage
This is a claim in which claimant alleges damage to her swimsuit resulting from uncured
paint at Sutton Pool.
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
Marie Ware, Leisure Services Manager
Jennifer Sheldon
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
Pam McCarron - Fw: Claim
From: Jeni Sheldon <jeni.sheldon @yahoo.com>
To: "pmccarro @cityofdubuque.org" <pmccarro @cityofdubuquei9rg >
..
Date: 7/16/2012 5:11 PM
Subject: Fw: Claim
Forwarded Message
From: Jeni Sheldon <jeni.sheldon @yahoo.com>
To:
Cc: "pmccarro @cityofdubuque.org" <pmccarro @cityofdubuque.org>
Sent: Monday, July 16, 2012 5:09 PM
Subject: Claim
Page 1 of 3
This communication and any attachments may contain information which is confidential'
and privileged by law and is for the use of the designated recipient. If you are not the
intended recipient, you are hereby notified that you have received this communication
in
error, and that any review, disclosure, dissemination, distribution or copying of its
contents
is prohibited. Please notify City of Dubuque immediately by telephone at (563)- 589 -4120
of
your receipt of these items and destroy the communication and any attachments
immediately. Further disclosure of this information may violate state and federal
restrictions.
Confidential information may include the following:
1) Social Security Number(s)
2) Medical /Health Information
3) Personnel /Disciplinary Information
4) Bank Account Information
5) Financial Information
6) Credit Card Numbers
If any documentation you desire to submit to the City of Dubuque contains any of the items
above
this cover sheet must be attached directly to the confidential information and indicate the type
of
information that is included.
Jennifer Sheldon , hereby certify that the attached documents
include the following protected information:
If any documentation you desire to submit to the City of Dubuque contains any of the items
above
this cover sheet must be attached directly to the confidential information and indicate the type
of
information that is included.
Social Security Number(s) Bank Account Information
Medical /Health Information Financial Information
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Personnel /Disciplinary Information Credit Card Number(s)
I understand that this information may be distributed within the City organization or to agents of
the
City for processing and I hereby authorize the City to act accordingly taking all precautions to
protect my information from unnecessary distribution.
Signature Date
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. 13
to 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.
1. Name of Claimant:Jennifer Sheldon
2. Address: 827 High Bluff Apt 1
3. Telephone Number: 563 - 495 -7748
4. Date of Incident:7 /12/2012 7/16/2012
5. Time of Incident: 1:30 pm
6. Location of Incident (Be specific): Very shallow end of pool Sutton Pool
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.) Went to pool on Thursady 7/12/2012 an when I left i realized there
was white paint of some sort all over the bottom of my swim suit. I was fine with that
just went out bouht another new swim suit for the year. Went to Sutton Pool on
7/16/2012 sat down an right awayu felt my butt peel off the bottom of the pool here to
find out that i was sitting on the crack of the pool an the calk is what is on my bottom. I
also saw other ladies with the same thing. I can not afford to buy a new swim suit
bottom every time I leave Sutton Pool.
8. What were weather conditions like? Hot
9. Give name and address of any witnesses: My kid shes 7
10. Did police investigate? (If so, give names of officers.) NO
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).NO
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.) yes 2 swim suit bottoms with white calk all over the butt. estimated price for
each is 17.00 dollars
13. What other damages do you claim, if any? NA
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.)NA
15. What amount do you claim from the City of Dubuque ?$34.00
16. Why do you claim the City of Dubuque is responsible? Because its a public pool an
the citys responsiblities to ,make sure that its safe. an i can tell you that peel calk
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probably isnt safe if a kid drinks it
17. Have you made any claim against anyone else for damages as a result of this
incident?
(If yes, give name and address.)NO
18. If the answer to Question 17 is yes, have you received any payment from that
source,
and if so, in what amount?
/Dated at Dubuque, Iowa this day of Monday July 16 , 2012.
(Signature)
Jennifer Sheldon
(Print Name)
(Rev. 7/12)
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