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Claim by Joan M. Overhouse THE CTTY OF DUB E MEMORANDUM Masterpiece on the Mississippi BARRY LINDAHL 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 Joan M. Overhouse Claimant Date of Claim Date of Loss Nature of Claim Joan M. Overhouse 07/05/07 07/05/07 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 Joan M. Overhouse 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 %~aim Form c~ ~~ '~ ~ ~ ~~~ ~ .You should complete this form in ~ ~~~~~ ainst the City of Dubuque, lava stitutes your claim ag orts your claim. ~ can .. tion that supP lA 52401 • It will then This written ~ any add~t~onat informa ~, Dubuque, that full and atta West 13 ~•~ s Office. Once Hall, 50 Attorney' will be Ci Clerk at City lion and to the Cam. Council• You The claim must be filed with the ty wdl be submitted to the C~tY ate dePa~1ent for rove nt-e dation referred to the aPPr~ ell, a report and rec:o-'n ration. ~; has the invesC+9ahon ~s comp of that report and recon-~ Ci of Dubuq Provided with a coPY the City Coundi. No employee of the ty aid. ion on aN claims is made boa as to whether year dasm will or will not be P The final dells re resentaf~on toy v ~ iJ authority to make any P M , - , 1. Name of Claimant: _ ~ 2. Address:. -- --. _ r_ ~- C ~. -rerepnone roumner: _ 5. Time of Incident: 6. Location of Incident (Be speC1~)~ ~ ~ ~~ f~'"n ,J e~~r- which you base rrerise that caused injury or damage• (Give full details upon 7: aessrilse the accident er cacse- ^~ your claim. If a City employee was involved, give the employee's name. r ' ~ U -c' ~ 'f" r ~ i° C ~~~UG '7'G E 8. What were weather conditions Eke? r ~. i,~ cil ~ r 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 desrxibe basis for ascertaining extent of damage) _ ~, ~----- 13. What other damages do you claim, if any? 7/5/2007 l~ttp://www.cityofdubuque.org/printer_friendly.cfm?pageid=l SS ,,. . ~,tarm Form. 1~. Rave you been compensated for any part or alt of your claim by any insurance company? (tf so, give name and address of insurance company and amount paid.) ~/ [~ U~ 15. What amount do you Gaim from the City of Dutwque? ~~ , ~Q , 1 18. Why do you. claim the City of Dubuque is responsible? c~ ~, Page 2 0(' 2 17. !-cave you made any claim against anyone else for damages as a result of this incident? (lf yes, give name and address.) ~~ 18. ff 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 . 2t}~ ~ -- (ignature) ~ce,~ ~'~~'~r" ~©v~-~ (Print Name) http://www.cityofdubuque.org/printer_friendly.cfm`?pageid=l SS 7/5/2007