Claim by Nicole KrausmanTHE CITY OF
DUB
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MF,MORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: July 10, 2013
RE: Claim Against the City of Dubuque by Nicole Krausman
Claimant Date of Claim Date of Loss Nature of Claim
Nicole Krausman 07/09/13 06/16/13 Property Damage
This is a claim in which claimant alleges damage to her swimsuit resulting from uncured
paint at Flora 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
Nicole Krausman
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 West st 13
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.
Name of Claimant:
1. Na
2. Address:
3. Telephone Number
4. Date of Incident:
5. Time of Incident:
6. Location of Inciden (Be specific):
7. Describe the accident or occurrence that ca {se iin'uu damage. (Give a full
details upon which you base your claim. If a City employee was
the employee's name.)
8. What were weather conditions like?
10. yid police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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.)
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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.)
15. What am unt do you claim from the City of Dubuque?
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16.
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by do you cI im the City of Dubuque is respons(ble?
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17. Have you made any im against anyone else for damages as a result of
thi incident? (If yes, give name and address.)
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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