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Claim by Linda StrongBARRY A. LINDAHL, ESQ. CITY ATTORNEY MEMO To: DATE: RE: Claimant Mayor Roy D. Buol and Members of the City Council March 1, 2007 Claim against the City of Dubuque by Linda A. Strong Date of Claim Linda A. Strong 02/22/07 Date of Loss Nature of Claim 02/01/07 Personallnjury This is a claim in which the claimant alleges that as she stepped off of the curb in front of 1951 Pierce Street, she fell on the ice, injuring her right ankle and foot. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. BAL:tIs cc: Michael C. Van Milligen, City Manager Jeanne Schneider, City Clerk John Klostermann, Street & Sewer Maintenance Supervisor Linda A. Strong 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 balesq@cityofdubuque.org CLAIM AGAINST THE CITY OF DUBUQUE, ' n~-- _ ~, ~rf~ ,~ , 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 13th 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 you as to whether ycur claim ~~,~ill or bull! rot be paid. 1. Name of Claimant: 2. Address: l 9~_S~ / ~ ,~ ~^ C ~ ~" v 3. Telephone Numbers ~ 3 ~~~~ ~y ~o o`~ ~02, 4. Date of Incident: / ~- CS 5. Time of Incident: ~~,~~s 6 ~~ 6. Location of Incident (Be specific): ~su17-e.- lr~ e y~7TrroPe /4'S ~ Pi Prr ~ ~~ 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.) 9 8. What were weather conditions like? _ ,.- / ffff -y~ _ / ~~~lt' W~7~3 C7 ~/CIfiT (:IUS/~h.~ ~:~ Cr)r;~>; ~~RC~I~°0~ ~~C2~~")iQl)~~E'gr'~~/.nCte~<nr~, 9. Give name and address of any witnesses: t~ ~n E 10. Did police investigate<? ((f so,//give names of officers.) t~"~(c P/ ~~ ('~ E' in !M I r >' ` ~h ~~~,ke ,~ hones o 11. Was a ne 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.) 1V D 13. Wnhat other damages do you claim, if any? IQ[~f"~<'n~ 2kOr~a7c~c' 1~+~'h~r~~c-in~A ~ocT . Sc~ei Jnd 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.) n~© 15. What amn/ ount do you claim f..rL~om the Cityf of Dubuque? / %0~4 ~ OCof(d/' arrac~c~~Ul IrPms "t-o~ ~~nP ~3 Clbo(/~ 16. Why~do you claim the City of Dubuque is responsible? /~ ~p ~ /n~o/'m ~c~ ~ tip e ~7'~ tS /'PSP~nS' J~~P T©r'_~_c_i[~T~L ShDU~nnrA JCS T/"c'?i~ r~r_7 /1P~ Irv7P 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 this ~_ day of ~ ~ ~ ~ `Signature) ,/" (Print Name) BARRY A. LINDAHL, CITY ATTORNEY MEMO To: DATE: RE: Claimant Mayor Roy D. Buol and Members of the City Council March 1, 2007 Claim against the City of Dubuque by Linda A. Strong Date of Claim Linda A. Strong 02/22/07 Date of Loss 02/01 /07 Nature of Claim Personal Injury This is a claim in which the claimant alleges that as she stepped off of the curb in front of 1951 Pierce Street, she fell on the ice, injuring her right ankle and foot. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. BAL:tIs cc: Michael C. Van Milligen, City Manager /Jeanne Schneider, City Clerk John Klostermann, Street & Sewer Maintenance Supervisor Linda A. Strong 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 balesq@cityofdubuque.org