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Claim by Mark Topf Copyrighted October 1, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Dubuque County Sheriff's Office for property damage, Bettye Kronstad for vehicle damage, Mark Topf for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Dbq. County Sheriff's Office Claim Supporting Documentation Kronstad Claim Supporting Documentation Topf Claim Supporting Documentation _ � �� GLAfM AGAIN�T T1HE CITY C3F DU�UQUE, 1{�V1/A �''� • � � ��-�� This wrifiten repQrt cc�nstitutes your claim against the City of Dubuque, lowa. You shvuld cor�p�et� this form in #utl and attach any additional infarmation that suppot�� your claim. The Claim musfi be filed with the +City Clerk a# Gity Hall, 50 W. 13t�' St., Dubuqu�a !A 5200'I. It � wi11 then be ref�rred by the City Cour�ci! to the apprapriate d.epartmen� far investigation. � C)nce that inve�tigation is completed, a r�port and recc�mmendatian will be scabmi�fied to the � City Council, You will be provided with a copY of tha�# report and recommenda�ion. � THE FINAL DECISIt�N ON ALL C�A111115 �S MADE BY THE CITY CCIUNCI�. NO EMP��}YEE OF f THE CITY C�F CIUBUQUE Hi4,S THE AUTH4RITY TU MAF�E ANY REPRESENTATIC}N T� YOU � AS TC} WHETHER YOUR CLAIM WI�� C1R WiLL NOT BE PAID. � 't. Nam� c�f C[aimanfi: � � � � ,� 2. Addre�s: _ ��"�� -� �� ,�,��l� �.��= � Cify: C.��" State: ,�'C��°,�- �ip: �`",��,�- � �� a 3. Telephc�ne Number: ,�� "',��''� �" ,�,� � 4. Date of Incident: �� , 5. Time of lr�cident; �,��""t�°�'�t�° �"-�" � r4-�` � � `�/ � �" �`� � .�i�C�t�� .�.�.�;� �. � 6, Locatian of Incident {Be specific) � �� G�-' � �� , � 7. DESCRIBE ACCIDENT OR C)C�U�RENCE THAT CAUSED [NJURY C}R DAMAGE. {Give fiuil details upon which you base your claim. If a City emplc�yee was irt�rolved, give the � emplayee's name.) � %�� lC� �`�It�� "�� Y� ��c�� 1� � 8. VIl�a�were weafi�ter conditit�ns like? � 9. Give name and address. of anywifinesses: .�'7�,�,��.�fY"� �,�5��1�' d�l'`�' �� h�� s`�v,�'v�c�e ,�� ;�'�� '10. Did pt�lice investigat�? �If sc,, giv� names of o�icers.) ��-��'�,.fi"�'' � � ; ��I. Was anyane tnj�red? (If sg, giv� n�mes, �ddresses, �r�d extent of injuries). �t� � � f I 12. Was any damage done tc� property? {9f sa, describe property and the �xfi�nt af damages. Attacf� estimates c�f damages or describ� b�si� for ascertaining extent of damage.} �d 1 G'�C a'�I C�C� �� "i�,� �=�c�f�� 7�1�d� t�� ,9fi�"��?"� !!��'�`�� i�'c:�- �d=.'�%G/I1�..�^ eC}f7T"F�X7"U`"� !�+ ! F1`c C.'�tr�1 L��i fC x f"t"d i� ,�tlir�`!K. V d"7"J Y s&a '��d-�� . ✓�J"""�"'/'f�i f..�lY 7`.�' �7�`�-C"l��`j}� 13. What ot1��r darnages d� you claim, if any? N�rY�' � 14. Hav� yc�u been cc�m�ensated for any part ar all caf your claim by any insurance � company? �If so, give name and adt�ress vf insurance compan�r and amoun� paid.) ; �� 15. Wh�fi amour�t do you claim from the Gity of Dubuq�ae? �° � � �� r 16. Why dca you cl�irt�a the City af Dubtaque is responsible? � �� -��i�-�-� f"� 1�.jr�� c�`7` t`��' �?t� �Z��' ��,��' � � '17. Have yc�u mad� any claim against �ny�ne else fc�r cla�rnages as a result �f�his incident? I {�f yes, give nam� and address.) !�''U �18, tf the answer to Question '�7 is yes, have you receiv�d ar�y paymerit fram fih�t �ource, and if so, in wha�. amount? � � a , '� Da�ted at �7u�buq�ue, iowa this �""" day of� ��`��I�/�� , 2� l�' . J` � �� S�gnature} ..�. � � . �� i �-�- �` � ,� � ' _ �l�� /c�1�'� (Prin� Name) � i�, � � j � � � � � �' �' �: � � � � � � � (Rev. 511�� 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 com'munication in error, and that any review, disclosure, dissemination, distribution or copying of its contents I! is prohibited. Please r�otify 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 indude the following: '��) ; 1) Social Security Number(s) 2) Medical/Health Information 3) Personnel/Disciplinary Information I 4) Bank Account Information ;;; 5) Financiallnformation !+ 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 and indicate the type of � information that is included. �i , i , ,I� �7 �, , hereby certify that the attached documents � include the following protected information: �� 4 Social Security Number(s) Bank Account Information � � Medical/Health Information Financial Information y � Personnel/Disciplinary Information Credit Card Number(s) � I understand that this information may be distributed within the Cit or anization or to a ents of the � Y 9 g � City for processing and I hereby authorize the City to act accordingly taking all precautions to protect my information from unnecessary distribution. ,f. ;� � h��z-� I�" Signature Date � � Copyrighted October 1, 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: Kelsey Caspersen for vehicle damage, Dubuque County Sheriff's Office for property damage, Bettye Kronstad for vehicle damage, Mark Topf for property damage, Brock Tyner for vehicle damage, Doug Winner for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation � ! a, � §g i THE CITY QF � U E 1VIElVIORANDUM � � Masterpiece on the Mississippi � TRACEY STECKLEIN �� PARALEGAL � � � . � To: Mayor Roy D. Buol and ; Members of the City Council ;, DATE: September 26, 2018 � i RE: Claim Against the City of Dubuque by Mark Topf � i�Claimant Date of Claim Date of Loss Nature of Claim � 'I Mark Topf 09/25/18 08/19/18 Property Damage ;I ,i � This is a claim in which claimant alleges that the front door to an apartment in claimant's i rental unit was damaged when police used forced entry to gain access to the apartment. Police were responding to a disturbance calL !I I This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa � Communities Assurance Pool. � cc: Michael C. Van Milligen, City Manager � Mark Dalsing, Chief of Police Mark Topf , � � � ! 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 �