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Claim by Jenny Cook Copyrighted February 5, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Robert Apel for vehicle damage, Carol Bandy for personal injury/vehicle damage, Jenny Cook for vehicle damage, Dubuque County Sheriff's Office for vehicle damage, Felderman Business Associates for property damage, Michael Gukeisen for vehicle damage, Joseph Ray for vehicle damage, Victoria Ruefer for personal injury, SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Apel Claim Supporting Documentation Bandy Claim Supporting Documentation Cook Claim Supporting Documentation Dubuque Co. Sheriff's OFfice Claim Supporting Documentation Felderman Business Associates Claim Supporting Documentation Gukeisen Claim Supporting Documentation Ray Claim Supporting Documentation Ruefer Claim Supporting Documentation i"� Ut"I � GL� ° CLAIM AGAINST THE CITY GF DUBUQtJE, IQWA �~�,�.� �e�� This written repor� constitutes yoc�r ctaim against the Gity of Dubuque, Ic�wa. You s�ould complete this form in full and attach any additional information that supp�rt� your claim. The Claim must be filed with the Ci#y Clerk at City Hall, 50 W. 13t" St., Dubuque, t,� �zaa�. It will then be referred by the City Council to the ap�propriate department for investiga#ian. C?nce that inv�stigation is completed, a report artd recomrnendation wi[I be submitted ta the � City Council. You will be provaded with a cc�py of fihat repr�rt and recammendati�n. � �� THE FINAL DECISIt�N ON ALL ��AIMS IS MADE BY THE CITY COUNCIL. NO EMPLC}YEE UF THE C1TY OF DU�UQUE HAS TH� AUTHORITY Tt� IViAKE ANY REPRESENTATI(JN Tt} Y{}U AS T4 WHETHER Yt�UR CLACM WIL� C1R WILL NOT BE PAID» � � " 1. N�me c�f Claimant: �� , � � �� ; 2. A�ldress: �� ' �� r 3. Telephone Nurnber: :>C�� " �� C � �, Dat� of l�cid�nt: j� �� ___ , 5. Time of Incid�n#: �t�� J 6. Lc�catit�n of lncident �Be specific}: �� t� ��" ��- G��` � `�° I� ��- �`�- � �� "�' ��i � �� 7. DESCRI�� ACCIDENT OR +C�CCURRENGE THAT CAUSED INJURY OFt DAMAGE. {Give � full de$ails upon whieh you bas� your �laim. If a City employee was involved, give the e��lsayee'� na�a�a�.� .�..a� .� , j� , ' / t�.�` 8 �„.,`, ,..,f-� � d4.dl."� �a ��-� 1 ht�.�°�.�'l�{' �,�'r "f� ��✓t��. ��°i� ��f f L�+� �/ {u )y.�#}.'- ��,.� '�j` �}" y � V 4 6t�. adSi�S "�6�D 4 @ �� f'� �.7 �°a'�..� . � � � � �Ar�r �� 8. What were weather condi�ia�ns like2 f� ��5� � `�c�.� �� - �' � 9. Give name and address of any witnesses: � 10. Did police investigate? {If so, give names of afficers.} �� 1'1. Was anyone injured? {If so, giv� names, addres�e�, and extent of inJuries). �� 4 I �yy ! f 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.) J f� 1 L n F� �. ��._�i' � �(.�Trl �.d. / � � 1.4� � �'lL'1 �� /�4'1.�� i�JC-�F�t�k � �,ir 't�L.�:'— . 13. What other damages do you claim, if any? '?uYl� 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.) , t�"1�� 15. What amount do you claim from the City of Dubuque? p > ., �/� `�.:;- ��C� 16. Wh(� do you claim the City of Dubuque is responsible? F�a:'�e.,-�� V��a�_�� rvr5 V�r'� �)v. �l�-�l �v��1�;�1� � �v'1ti.Ec:�l. �� '� C�z�L tL�'- i Vl C_��'� �):_.�k�ItS�;e t" - 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) ��1�, 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so in what amount? �/lr� Dated at Dubuque, lowa this �� day of ��ti��'� ' , 20 �G' . �� ~ .-�'�'�— (Signaturej t �yi% � �-►ti� �l � (Print Name) vy C"� � -��';"� � -�; -. _ a_ r�-� =' �t � - _ � (Rev. 7/12) - _-- � t— �,.� �,p_;,.,•i ..' �_,_:�� -C� �i -i::' —* !'; CLl � Jenny Cook's narrative of the accident on 1/23/2018 in the City parking lot at Kerper CT: I,Jenny Cook, was driving the City of Dubuque Animal Control truck, a silver 2017 Dodge Ram 1500, on 1/23/2018 at 1:05 pm, when I came into the City's parking lot on Kerper Court, as I approached the corner of the lot where I was slowing down to stop,the truck was not stopping. I proceeded to slide for several feet (approximately ten) and hit my own parked personal vehicle, a red 2002 Chevrolet Malibu, in the driver side rear corner panel. The City's truck sustained scratches and paint transfer on its passenger side front metal bumper. My personal vehicle sustained more damage, the plastic bumper has large scratches and a dent in the metal corner panel. I backed the truck up and took photos of the damage to both vehicles.The ground was very slick, it was difficult to walk on. McKinzie Flanagan was present in her vehicle which was parked next to my personal vehicle, but she did not witness me hit my own vehicle. Flanagan can confirm how icy the parking lot was. I was not injured during the incident. I would guess my speed to be less than 15 miles per hour at the point of impact. Both vehicles were drivable after the incident. I immediately called Mary Rose Corrigan and explained what had occurred. She told me to call Tony Brightbach, I called Brightbach he said that I needed to fill out a Vehicle Damage Report and he would investigate what needed to be done with my personal vehicle. He thought that I would have to file a claim with the city. I asked him if this could be done tomorrow due to it being near the end of my shift and I needed to debrief with my co-worker. He said it was okay to do the report later. I then called the City's public works department and asked that they put salt on the icy area. The City's truck was later taken over to the City garage by McKinzie Flanagan.They wiped the paint transfer off the truck,there are still some very minor scratches on the metal bumper.The guys in the garage were not concerned about the truck in any way. I Confidential This communication and any attachments may contain information which is confidential and privileged by law and is for the use of the designated recipient. If you are not the intended recipient, you are hereby notified that you have received this communication in error, and that any review, disclosure, dissemination, distribution or copying of its contents is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of your receipt of these items and destroy the communication and any attachments immediately. Further disclosure of this information may violate state and federal restrictions. Confidential information may include the following: 1) Social Security Number(s) 2) Medical/Health Information 3) Personnel/Disciplinary Information 4) Bank Account Information 5) Financial Information 6) Credit Card Numbers If any documentation you desire to submit to the City of Dubuque contains any of the items above, this cover sheet must be attached directly to the confidential information. Please indicate below the type of information that is included. I, l�-��-Ly- -(i�= , hereby certify that the attached documents include the following protected information: Social Security Number(s) Bank Account Information Medical/Health Information Financial Information Personnel/Disciplinary Information Credit Card Number(s) I understand that this information may be distributed within the City organization or to agents of the City for processing and I hereby authorize the City to act accordingly taking all precautions to protect my information from unnecessary distribution. Signature Date I have read the information above and do not have any confidential documentation to submit to the City of Dubuque as part of this Claim Against the City. L.�t� ' � � Signat e Date Copyrighted February 5, 2018 City of Dubuque Consent Items # 3. ITEM TITLE: Disposition of Claims SUMMARY: City Attorney advising that the following claims have been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool: Robert Apel for vehicle damage, Carol Bandy for personal injury/vehicle damage, Jenny Cook for vehicle damage, Dubuque County Sheriff's Office for vehicle damage, Felderman Business Associates for property damage, Michael Gukeisen for vehicle damage, Joseph Ray for vehicle damage, Victoria Ruefer for personal injury. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo THE CTTY OF � . D'�...JB �� E MEMORANDUM Maste iece on the Mississi i '� PP 1�(HIFiC T a�7 I ELF\Lt � l� rl A.3i' �/— PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DaTE: January 26, 2018 RE: Claim Against the City of Dubuque by Jenny Cook Claimant Date of Claim Date of Loss Nature of Claim I� �Jenny Cook 01/25/18 01/23/18 Vehicle Damage � , � This is a claim in which claimant alleges that she, a City of Dubuque Health Services � employee, while operating a City of Dubuque Health Services vehicle, entered the City's � Kerper Court parking lot which was slick due to the weather conditions, and struck her ,� personal vehicle which was parked in the lot with the City vehicle. i� This claim has been referred to Public Entity F2isk Services of lowa, the agent for the lowa � Communities Assurance PooL cc: Michael C. Van Milligen, City Manager Mary Rose Corrigan, Public Health Specialist Jenny Cook � , OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org �