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Claim by Kara LarsonTHE 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: August 14, 2007 RE: Claim against the City of Dubuque by Kara Larson Claimant Date of Claim Date of Loss Nature of Claim Kara Larson 08/14/07 07/19/07 Property Damage This is a claim in which the claimant alleges damage to her swimsuit resulting from uncured paint at Flora Pool. According to Gil Spence, Leisure Services Manager for the City of Dubuque, this claim pertains to the City of Dubuque Flora Pool Painting Project. Fred Jackson Tuckpointing was retained by the City of Dubuque Leisure Services Department to provide painting services for the Flora Pool Painting Project. The contract required the standard form of contracts and bonds to be filed with the City, which requires Fred Jackson Tuckpointing to hold the City harmless from any claims of damage resulting from the work. It is therefore the recommendation of Gil Spence to forward this claim to Tricor Insurance and Financial Services, insurer for Fred Jackson Tuckpointing, for its consideration. The City Attorney's Office concurs with this recommendation. BAL:tIs cc: Michael C. Van Milligen, City Manager Jeanne Schneider, City Clerk Gil Spence, Leisure Services Manager Kara Larson OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 30O MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EnnAIL balesq@cityofdubuque.org a ~ ; 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 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 your claim will or will not be paid. 1. Name of Claimant:` , , 2. Address: l~~ V '~~~~ ~~ 3. Telephone Number GJ ~~1' ~ ~ ~% ~ - 4. Date of Incident: 5. Time of Incident: .~ 6. Location of Incident (Be specific): ~~ .~~~~ ~~~~J 8. What were weather conditions like? 9. Give name and add{qss of any witnesses: 10. Did police invelstigate? (If so, give names of officers.) 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 11. Ways 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.) . 13. What other damages do you claim, if any? 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? 17. Have you made any claim. against anyone else for damages as a result of this 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? Dated this ~ ~ day of ~~ , 20~_. n ~~~~`"" ~ C~ Gam-, ( natur ~ ~' ~ ~ (Print Name) y-= ~ ,~, i~ cn