Claim by Hope McDermottTHE CITY OF
DUB E
Masterpiece on the
BARRY LIND
CITY ATTOR
To:
DATE:
RE:
Claimant
MEMORANDUM
Mayor Roy D. Buol and
Members of the City Council
November 19, 2007
Claim Against the City of Dubuque by Hope McDermott
Date of Claim
Hope McDermott 11/15/07
Date of Loss
06/01 /07
Nature of Claim
Personal Injury
This is a claim in which the claimant alleges that she injured herself after she tripped
and fell on an uneven portion of sidewalk outside the Carnegie Stout Library.
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
Susan Henricks, Library Director
Hope McDermott
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
Home Pie :Departments :City Clerk :Claims against the City : CI81171 FO~ItI
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City Clerk (/ ~~~ ~ J% ' ~~ t `
First floor of City Hall, 50 W. 13th Street ` ' ~ ~~: - ~ j
Phone: (563)589-4120 ~~ ~ ~
Fax: (563) 589-0890 ~ ~ „~, ~`, „(.r
Hours: 8 a.m. to 5 p.m. Monday through Friday ` , ~~- -/'~ i~
Email:ischneid@citvofdubuque.orn ~-~r ~ ' ~
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
authority to make any repres ntation to you as to whether your
1. Name of Claimant: ~ I G
2. Address: L
3. Telephone Number:
4. Date of Incident: ~' ~ `
>yee of the City of Dubuque has the
will or will not be p id.
~~
5~~~
5. Time of Incident: ~1.`l9o t4M
L ~ ~ 'C"t J`~ -
6. Location of Incident (Be specific): Y'tr 1 Wc~~r:~ VV }t) (~ (`~ a ~~
~ ~
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.)
l~?h~ 1 e y,f c~\~in~ ~n~y `~'t~~ L~bcr.>Lr~ , ~ SI i~~~ e~~ rnu~~ ~ taa~r,
8. What were weather conditions like? ~ ~~ ~^o~~ +n ec~ C\ur~ ~~~1'n~, +~ ~~1.~" ~3~.~*~ ~'~-
~~'J'(`a r I Gt n~ CN, ~~ 0.C~~Qew~}
9. Give name and address of any witnesses:
~10. Did police investigate? (f so, give names of officers.) ~ y~ C 1_
11. as anyone injured? (If so, give names, addresses, and extent of injuries.) el 11~~,1('t e~°
r~~~~rnu ~ t c~-~S~ ~~ s ~ C~~~J~S ~ ~~ ~f~m~
~r~QeS . Sw~11en ~ r~,.-'t' ~,neFS ~ neck. ~~~ Ir~c~ a~~
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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.) .~ ~~~, M~ r ~#~, r ~C,n~~
http://www.cityofdubuque.org/index.cfin?pageid=155 7/25/2007
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Claim Form
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Page 2 of 2
13. What other damages do you claim, if any?
14. Have you been comp
and address of insurance
and
~~o~,,
all of your claim by any insurance company? (If so, give name
paid.)
15. Vuttat amount do you claim from the City of Dubuq
-' -
16. Why do you c aim the City o Dubuque is responsible?
.~9 ~(-(2a~ ~$I I ~9
17. Have you m'~de 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 ~(1~itPiv-v~~Y!~ , 20~~
(Print Name)
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City Hall, 50 West 13th Street, Dubuque, Iowa 52001
http://www.cityofdubuque.org/index.cfin?pageid=155 7/25/2007