Claim by Joseph Ray 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
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ����
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This written report constitutes your claim against the City of Dubuque, lowa. You sho�°Id
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 W. 13t" St., Dubuque, IA 52001. It �
will then be referred by the City Council to the apprapriate department for investigation. �
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. �
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THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF �i
THE CITY OF DIJBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU �
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAtD. �i
1. Name of Claimant: � 1�,��=-e��'� �.. � �� �� 1�
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2. Address: C ��C� ( ��� �1,�_ �'"Z... l� , ��� ..�� � �3C�Z. ,�
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3. Telephone Number: � �l��l) � �.� �- 2'D�� �I
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4. Date of Incident: � l.S f/ �' �
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5. 'fime of Incident: �� r� � `� ��
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6. Location of Incident (Be specific): ��l��(�/�- ��" "f �/�`� C� �%�� I �`�~�' �f�` �j
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7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you base your clairn. If a City employee was involved, give the
employee's name.) �
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8. What were weather conditions like? i(,����� �
9. Give ���� ard atidress af ar��witr�esses:
10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries). �
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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.) �
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13. What other damages do you claim, if any? r040 �- I�
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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.) i
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15. What amo nt do ou claim from the Cit of Dubu ue?
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16. Why do you claim the City of Dubuque is responsible? �;
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17'. Have you made any claim against anyone else for damages as a result of this incident? ;
(If yes, give name and address.) ;j
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18. If the answer to Question 17 is yes, have you received any payment from that source, �;i
and if so, in what amount? '
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Dated at Dubuque, lowa this � day of t C.�i�- , 20 ��'.
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(Signature) „
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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.
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Confidential information may include the following: j
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1) Social Security Number(s) �
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2) Medical/Health Information ij
3) PersonneUDisciplinary Information �
4) Bank Account Information ��
5) Financialln�Formation ��
6) Credit Card Numbers �
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If any documentation you desire to submit to the City of Dubuque contains any of the items above 'i
this cover sheet must be attached directly to the confidential information and indicate the type of ;I
information that is included. '�
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I, , hereby certify that the attached documents "'
include the following protected information: ��
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Social Security Number(s) Bank Account Information �
Medical/Health Information Financial Information �
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Personnel/Disciplinary Information Credit Card Number(s) �
I understand that this information may be distributed within the City organization or to agents of the �
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City for processing and I hereby authorize the City to act accordingly taking all precautions to �
protect my information from unnecessary distribution.
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Signature Date
I have read the information above and do not have any confidential documentation to submit to the �
City of Dubuque as_ of this Claim Against the City
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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
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THE CTfY 0�����F �/'_..-/
��.TB � '[.�E MEMORANDUM
Mc�sterpiece on the Mrssissippi
TRACEY STECKLEIN �
PARALEGAL
To: Mayor Roy D. Buol and �
Members of the City Council �
DATE: January 18, 2018 �
RE: Claim Against the City of Dubuque by Joseph Ray
Claimant Date of Claim Date of Loss Nature of Claim �
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Joseph Ray 01/17/18 01/15/18 Vehicle Damage ;
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This is a claim in which claimant alleges that a City of Dubuque fire truck struck the mirror I
of claimant's vehicle which was parked near the intersection of Nevada Street and p
University Avenue. j
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This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa �
Communities Assurance Pool.
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cc: IVlichael C. Van Milligen, City Manager �
Rick Steines, Fire Chief N
Joseph Ray �
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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
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