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Claim by Eagle Window & Door Copyrighted November 5, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Claudette Coleman for vehicle damage, Eagle Window& Door for property damage, Lori Lewis for vehicle damage, and Sandra Wolbers for personal injury. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Coleman Claim Supporting Documentation Eagle Window& Door Claim Supporting Documentation Lewis Claim Supporting Documentation Wolbers Claim Supporting Documentation , _ �� c��n� ��e��T -rH� c�T�r aF �uguc�u�, �owA � �t�� a This written repc�rt constitutes your claim against th� Gity of Du�uque, lawa. Yac�s� uld �� G complefi� this form in full ar�d afitach any additic�nal inform�tion that suppor-ts your claim, � z Th� Claim must be fiied with the City Clerk at City Hall, 50 W. �i3t"' �fi., Dubuque, IA 520Q"i. Ifi � will then be referred by the City Cou�zcil to the apprapriate depa�Em�nt for invesfiigafiion. ` Once �hat investigation is comple�ed, a repart and recammendation wi[1 be submitt�d to the City Council. You witl be prt�v�ded with a copy c�f�thafi report �nd recommenda#ion, r THE F1NAL, DEC1SIflN C}N ALL CL.AIMS IS NIADE BY THE CITY COUNC[L. NC? EMP�OYEE QF � THE CITY C7� DUBUt�UE MAS THE AUTHt�RITY T4 MAKE ANY REPRESENTATION TtJ Y`C}U � AS TC) 1NHETHER 1(O�lR CLAIM W1E.L C�R W1LL NOT BE PAID. �' ��-' �,�� i _ � � � 'i. Name of Clairnant: �- 9 �t �� Z. Acldress �—� : �� `�P"` �, _ � �� __ �,-�--y� . � C�ty: j��'1�- State: ...�. l�t Z[p.`� _ �" i --c. �. _ `� �_`�' � 3. Telephon�e Number ""��'��"��J�� '�'�� ' , 4, Dafie of lncid�nfi. �� ° �� '�� '�. �s r ` �ca �� 5. Time of Ir►ciclent: �� r�� i �" �� tr��-`��~ �� - � 6. [.ocation of lncident {Be specific): �� C.�vt�5� `�" ��' �t�.��- � �t�� ,; , 7. DESGRIBE ACC[DENT �R 4CCURRENCE THAT CAUSED INJUF�Y OR DAMAGE. {Give ' ftall de#ail� upon which you base your claim. 1f a City e�n�loyee was �nvolved, give fhe� � emplayee's n�me.) P � � ��,.:+�.�� `��..-��n��- �+��-� �� " �� '�� - � �.i` �''t.,JC��' �' �1�t � �..��Y� � °t�... � �r�� rac��tJ/'�.- c�,�r� C�1CC��1 ,1 � � 8. What were weather condition� like? � � r,��,.�` ��d'c�tt � �r��'� �� a�� . Give name and address. of anywitnesses: . ��t�� e..�r�R�'�"� � ��1��.��tt� �►� . . � 'i0. Did palice inv�sti�ate? (If sa, give names of officers.} � �� 'i'�, Was anya�e injured? {I�SOi C„�.iVf; C1r1IT1CS� addresses, and e�ctent c�f injuri�s). � �� 1 � 12. Was any damage don� to praperty? {[f so, describe property and the ex#ent of damages. A�tach estimates c�f darrtages or describe basis for ascer��ining extent of damage,} b ��.5 ��t� `� � ' t'i��'��" �'�C�� °'�vy�.�.3 ��}f�'t "�'�C1C,�; �� v, X' � � � � � k '�� t�..twc�fi��n t� � �� Dn� �°��t�� . `��c��. � �� ,��:��`d�. � � �i3. Whafi other damages do yoc� claim, if any? ��rC�� ' ��r:� ��{� {`5..,� �k� �� P � � . �. . . .. • � - � � � . � � �14. Have y�ou been comp�ns�ted for a�ny part c,r all of your claim by arty insurance � �ompany? �if so, give r�ame and adEdress af ins�rar�ce compar�y an�i amaunt paid.) ; � t �r� t��t� �� i� � �i �C �t� � �� C ��cAc� ; �� '15. Vilhat am�unt��c� ou claim from the City of aubuq�ae? , A f I f 16. Why cfo you c aim fi�e City caf D buque is responsibpe`� � ,�i� �� ,.� � ,� ��c�- � ��` �� e.. h��c�S I��r4. c�n�.��'" ' � C�t�� "'��; �v�� d �"�e�EtrtP��t�O�r'r►� �� cs�ik- �� : afc�a,�� c��9�5 � '17, Have �o�t made any cla�m ag�inst �n�tone el�e far dam�ges as a result c�f this in�ider��? ��'v`��-- ' {If yes,/� ive rname and addr�ss.} y ��.�i./. °� �P.�'��.C7o �� . �41��(.� �� . � �� -. .. L. 4°el. . �� i t� f t��✓i.t,r.- . �iL++VFx. 'A.;,l ['/. �'�' ��Ptl� cJ�r�`.a � . � � f 18, 1f th� answ'er fic� Gtuestion '�7�s �s, have c�u receiv�d an a mer�fi from that sc�urce � Y � YP Y � and if sa, in what amount? i , E �a��d �t �r��tac�t��, l�v�� d�y �f �� ..t'� �(� ��1 . � � � , � � ' � � , , �ao.�.,.� 1 �Sic�nature} � ; P� � ��.�� Prin� Name ' ��.��+�x��' ,�' ( ) ; i :::� � i � ; ;�� ; �" ��' � '�; � cr —� ��""�.. (Rev. 51't 8� � �� c�nfidentla! � This commun'tcatic�n and any attachments may contain infarmation which is confi�lential and privileged by l�w and is for the use Qf the designated recipient. If you are not the ir��ended recipient, you ar'e hereby notified thafi yau hav� received this cammunication irt errc�r, and that any review, disclosure, dissemination, distribution c�r copying af its ean�ents � i� prahibited. Please notify City of Dubuque immediately by telephor�e at {563)-589-412� of � yc�ur rece�pt of these �tems �nd desfiroy the comrnunicat�or� an� any attachments E imm�diately. Further disclo�ure of this infarmatie►n may violate state and federal � re�trictions. , � q � ,i ,; Confiden�ial information may includ� the follovvir�g; � 1} Social Secc�rity N�mber�s} F 2) MedicallHe�lth�Informa�ian � � � � 3} Personn�llDisciplinary Ir�formation � 4} Bank Accaunt lrtformation : 5) Finan�iaE lnf�rrnatian � t �i} Credit Card Numbers } 1f �ny d�cumenfiation you desire ta submifi to fihe City of Dubuq�e cor�t�ins any of the items above this eQver sheet must be attached directly tc� fihe c�nfidential infarm�tiQn an� indicate the type of ir�forrnation that is included. �j E i' k � ! i I, , hereby cerkify that the attached documents ; incl�d� the following protecfied information: ': � S�cial Security Number{s) Bank Accc�unt Information �E � MedicaflHealth Informatic�n Financial lnfarmat'ron ` � � � � i P�r�c�r�n�€IDis�iplinary Ir�formati�� Credit �ard ��mber{�) � I undersfiand that fihis ir�fc�rmation ma�r �e distribufied within the City organizatit�n or t� agents of fihe I City for processing and 1 hereby aufihc�riz� fihe City to act accordingly taking ail precautions to protect my tnformatic�r� frc�m unnecessary distribution. ' ��' ��"l� �ign�ture Dafie Copyrighted November 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: Claudette Coleman for vehicle damage, Eagle Window& Door for property damage, Lindsay Lannen for property damage, Lori Lewis for vehicle damage, Sandra Wolbers for personal injury. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation � � THE CITY OF � �,�. ��i B ^ E MEMORANDUM Masterpiece on the lvlississippi TRACEY STECKLEIN � , PARALEGAL �I To: Mayor Roy D. Buol and I Members of the City Council ' � DATE: October 19, 2018 'i RE: Claim Against the City of Dubuque by Eagle Window & Door � �;� Claimant Date of Claim Date of Loss Nature of Claim � i Eagle Window & Door 10/17/18 07/19/18 Property Damage ,I� '� This is a claim in which claimant alleges that the claimant's sprinkler lines on claimant's ��j property along Kerper Boulevard were damaged when City trucks ran over them. �;�; This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa 'I� Comrr�unities Assurance Pool. �' � cc: Michael C. Van Milligen, City Manager John Klostermann, Public Works Director Brandon Schardt, Eagle Window& Door i � � 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