Claim by Tracy LittleTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL I~
CITY ATTORNEY
To: Mayor Roy D. Buol and
Members of the City Council
DATE: July 13, 2007
RE: Claim against the City of Dubuque by Tracy Little
Claimant Date of Claim Date of Loss Nature of Claim
Tracy Little 07/11/07 06/15/07 Property Damage
This is a claim in which the 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.
BAL:tIs
cc: Michael C. Van Milligen, City Manager
Jeanne Schneider, City Clerk
Gil Spence, Leisure Services Manager
Tracy Little
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3O0 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.org
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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. 13th 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 DUBUGIUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO
YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: Y`G ~~ 1+`~' ~~
2. Address: ~5 5 f'Y]ou y~~ ~- l~, ne ~~
3. Telephone Number: ~57" ~w~3
4. Date of Incident: ~U Yl ~ ~ J~'
5. Time of Incident: ~~~ (been 1: 3D - ~ ~<30
6. Location of Incident (Be specific): ~l~r~ p0~ I /,~ ~~~e '~
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?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
11. Was anyone 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.)
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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 amount do you claim from the City of Dubuque? ~®,~~ f~ /' ~~ ~~s~-
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16. Why do you claim the City of Dubuque is responsible? ~C'~iGrsz LUhPh Z' ~// c/
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18. the`~nsv~r to Question 17 is yes, have you received any payment from that source,
anso,aq wF~~mount?
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Dfit~ed a~pub~q~, Iowa this ~~ day of I 20 ~~ .
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(Signature)
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(Print Name)
(Rev. 1/00 & 7/01)
13. What other damages do you claim, if any?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) ~ I /1