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Claim by Dubquue County Sheriff's Office 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 � �� CLA[M AGAINST THE C1TY QF DUB�IQUE, IOWA � � � This written rep�rt constitufies yc��ur claim against the City c�f Dubuque, lowa. Yau should complete this fc�rm in full and at�ach any additional information fhat s�pporEs your claim. _ 4 � The Glaim must be filed with the City Glerk at City Ha11, �t} W. 13t" St., Dubuque, IA 52001. It ° will then be refierred by the Cifiy Counci[ to the appropriate department for investigation. 4nce tMat investigation is completed, a repQr� and recommendation wi11 be submitted to the City Council. You will be provided with a copy of thafi repart and recommenda�ic�n. � THE FINAL DECISIC3N C3i� ��L� �.LA111�� IS MADE BY THE C�TY COIINCIL. NC} EMPLOYEE OF � THE CITY tJF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TU YaU � AS TO WHETHER YUUR CLAIM WILL 4R WIL� NUT BE F'AID. � , i , „, : '1. Name of Claim�nfi: ��c,�� ..-��,`�".M, �� '� � a � �-� ., � � � H N 2, Address: `�"�� ,�� °� �� il � '� 3. Telephone Number: ��C+`�� "�1�� 4. Date of Incid�nt: � �' �� ; 5. Tim� af ln�ident: �� ».� � � � 6. Location of #ncident (Be specific}: � � ��-- �c�€� ��'; ��, �-r�� -�� -� � � 7. DESCRI�E ACCIDENT OR t��CURFtENGE THAT CAUSED INJURY t3R C}AMAGE. {Give full de�kails upon which yau ba�e your claim. If a City employee was invalved, give the employee's name.} � q � ��1'�'�,, � �1 ��'+ � k� � ��G�� '[�i�P �� G`�(' {��° � � �4� � �1� �t�e � ..� �� C� \ �f�� 0.d *`� L�� !� � �`� ��ti C��F� �'-f•r� �� 1��^�, � a � �� ..� 8. What were we�ther canditians IiP�e? �� D�� "� �� 9. �i�e �arn� ��a� �d�r�� #��r�06��: 10. Did police investigate? �If so, give names of ofFicers.} �c� � ��`c��p� � � �� 11. Was anyane injured? (If so, �ive names, addr�sses, and extent of injuri�s}. � � � � i 3 '12. Was any damage done tc� property? {If so, describe property and the extent of ' damages. Attach estimates of damages or describe basis ft�r ascert�ining extent a#' damage.} �(1!'tfV��. C. •' {� �j} `- i �i � Ot i. '+t t L.. �'L !' 7.J !"+d ' :i J { t V"V'Lt� ' " � t Cf�{7 J J .f c1 � � t 3 93. What c�fiher damages do you claim, if any? � � , 1A�. Have yau been compensated for any par� or a!1 of yc�ur claim by any insur�ance � company? (If so, give name and adclress of insurance company and amount paid.� � s �� i 15. What�mo�nt do you cla�m fram the City of Dubuqu�? � „ ��'�'�� `, � 16. V1Ih do yo� claim the City of£}ubuqu is respansible? � ,, ¢ �{ � � �r�� a.�- k c�. '�l�u c�t e� ��` �r.�, ��.�� v� � �-�-.� C��-E�; c�v-- �; 17. Hav� yc�u made any claim against anyone else for damages as a result of this in�ident? ; �If yes, give narne and �ddress.} 1 � � � 5 r 18. If the answer to Ques#ion 1? is yes, have you received �ny payment frot�e� that source, � and if so, ir� what amc�unt? � 8 � � � Dated at Dubut�ue, Ic►wa this � � day of ��.c��., , 20��,. � ' i � �. � (Signature) � ��. � - ��t�..� �� Print Name} @ �— � � � {Rev, 7/12} ��:� � �; _ � ,� � �� ;� �: r�� t �»� � „�� t... .n. �� c'�� ``� �§ " " �:�°� :..�"�h �" ; ��" 4" �..� � € �:£�ry •�' «,�,� � � � � � 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 �LTB U� MEMORANDUM Maste�iece on the Mississippi TRACEY STECKLEIN � PARALEGAL ' , �I � � � � To: Mayor Roy D. Buol and " Members of the City Council � �i DATE: January 23, 2018 ; , RE: Claim Against the City of Dubuque by Dubuque County Sheriff's Office � Ij Claimant Date of Claim Date of Loss Nature of Clairr� �� I� Dubuque County 01/22/18 01/15/18 Vehicle Damage � Sheriff's Office � i This is a claim in which claimant alleges that a City of Dubuque police ofFicer was backing 'i up a City squad car in the DLEC parking lot and struck a Dubuque County vehicle. � � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa � Communities Assurance PooL � i� � cc: Niichael C. Van Miiligen, City Manager ;r Mark Dalsing, Chief of Police � Dubuque County Sheriff's Office � 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 i e