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Claim by Andres Leza Copyrighted March 4, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUM MARY: Hope Ehlinger for vehicle damage,Audrey Gottschalk for vehicle damage, Zachary Hallman for vehicle damage, Andres Liza for property damage, Kalyn Nowacki for vehicle damage, Conor Shoellhorn for vehicle damage, Nicole and Ricardo Woods for personal injury/vehicle damage, SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Ehlinger Claim Supporting Documentation Gottschalk Claim Supporting Documentation Hallman Claim Supporting Documentation Leza Claim Supporting Documentation Nowacki Claim Supporting Documentation Shoellhorn Claim Supporting Documentation Woods Claim Supporting Documentation �� This written repo�t constitutes your claim ac�ainst the City �f Dubuque, lowa. You should '��`°^, compiete this form in full and attach any additional information that supports your claim. f�.�-}-��- The �laian must be foled with the City Clerk at City Hail, 50 W. 13t'' St., Dubuque, IA 52001. It will then be referred by the City Council to the appropriate department for investigation. Once that investigation is completed, a report and recommendation will b� submitted to the �� City Council. You w611 be provided with a copy of that report and recommendation. � THE FINAL DECISlON ON ALL GLAIMS dS MADE BY THE CITY COUN�IL. NO EMPL4YEE OF � TFiE CITY OF DUBUQUE NAS TNE AIJTH�RITY TO MAKE ANY REPRE�ENTAT{ON TO YC3U '� AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. ' °�. Name of Cla�mant: __ � n c��'eS �.eZc� � 2. Addr�ss: �J�'�I� S'n e 11, /��enue. � ,� ; „ City: M��a�c, o��`s State: �� Zip; _ �'S'�4� ', fl 3. Telephone Number: �� ' 3��.� � ,; ;; �, �Ui� -- �ec , �vf$ (i 4e Date of Incident: �Ic�u ;; !i 5. Time of Incident: (�n ��n�wn_ H � 6. Location af Incident (Be �pecific): �I�� f� Cl�.:�l� Q�rv� , ��v��c;v�. L� _S��? I !f ( � �G,'�,Ac� � �--c��,or'�h U'v�.. � ��-�.rt'a� ,A- ��.d--e.r r?�� , �' � � � J �. �EeS�.Rf�E ACi�s��E�T �� C�su�.��rE T�AT Ci/Q�SE� ��.��R►� �Ri. DQ.�I��JE. t�Ji1V"� q fiull details upon which you base �rour cl�im. If � City employee was invoived, give the � �mployee's name.) �� a � w (�C�u. c�h�S o� i� ��-�r�v�� - �,`f� � � �2� I"1'c� ('arh rA�,1 S�ct �S� Stl"�.r��',"% j �G. �"� e •�v �`�`-c r� r� � p; 8. What were weather canditions like? I�r� � � 9. Give name and address crf anv witr��sses: I��- � .., ... P ..__ . _ g ' i � ' -- � -�u. usc� �oAice �r�vesYi aie. ir so give r�ames oT officers.j P1 I I_ 1 `� O 1� ce �rVe�'e C,�,.�1 e� � � �'ne �, s�e�--�•, �1�� or �- �Cn�W �� }lu� i'n�e�d�y�� 11. Was anyone injured? (If so, give names, addresses, and extent of injuriesj. I N//� Copyrighted March 4, 2019 City of Dubuque Consent Items # 3. ITEM TITLE: Disposition of Claims SUMMARY: CityAttorney advising that the following claims have been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool:Audrey Gottschalk for vehicle damage, Andres Leza for property damage, Kalyn Nowacki for vehicle damage, Conor Shoellhorn for vehicle damage, Nicole and Ricardo Woods for personal injury/vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo � 12. Was any damage done to pro ert ' p p y � p y. (!f so, describe ro ert and the extent af damages. Attach estimates of damages or describe basis far ascertaining extent o#' � d�mage., , � �G�t,�(�e �c�a� ,� c3�enih9 Yh�C�Gnisr�. Ij � ; L� re en� , ��.��x�,,,� .� � -------- i:��-urb,- ��JS h,ere c�a�,c.}�� 1rc-r,zs , S�r�n �a� �ar� C�tJ�- s� �av �- 1 rn 13. What other dara�ages do you claim, if any? �a��`j a n +�h� caVr� I-�r � � Q x � � �� p, 1d. Have you been compensated for an art or aN of our 1 ' '' Y p y c air� by any ons�pance �� company? (ef so, give name and address of insurance corr�par�y and amount paid.) I� -j � �� , b:�� T h�� L.a.,j� ��'e S eC,Urt�� [e�,"� � 15. What arr�ount do you ciaim from�the City of Dubuque? '� � � iV _ � � L��-, v s s s�`i► � 16. 19Vhy do you ctairn the Ccty of Dubiuque is responsible? '! � ' S ' � �ha. �� ✓�� 2.c ��' �0%�+Ci 1� ol �, 'I� II IS fe5�'bnst�alo �yY C7u��6rix 'f`�tu�- 0 GGv��`e� �-j.Ut f� 2c't 'i 17. H�rre you made any claim aga6r�st anyone else for darrfages a�a result of this ir��ident? � (if yes, giv� n�r�e and address.) i n,�� ____ i� 18. if the �nswer to Question 17 is yes, have you receiv�d any payme�t fr�m that sourc�, ,` and if so, in onrhat amour�t? I �ated at Dubuq�e, lowa �his a'a d�y of �C�fUe�r�. 2a II� r ' �� d="�../''—� . (�ignature) ^ i`�`S 1 n? � � � (i�rlr�t Name) �� ,-- � � ��s- �� C(`� � � T, �'� c._ "'"`� �'�� c�` .,� .._W,.. {Rev. 5/18) �'�' � � �.s �� ' � 4. � ct� � THE CITY OF I.�U� � � MEMORANDUM MasterJaiece on the 1VIisszssippi TRACEY STECKLEIN �v"" I PARALEGAL To: Mayor Roy D. Buol and I� Members of the City Council DATE: Februa 25, 2019 rY RE: Claim Against the City o#' Dubuque by Andres Leza �' ; Claimant Date of Claim Date of Loss Nature of Claim Andres Leza 02/22/19 Nov-December 2018 Property Damage I i This is a claim in which claimant alleges that his tenants who participated in the City of � Dubuque Lead Hazard Control & Healthy Homes Program caused substantial damage to � landlord's property. 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 : Alexis Steger, Housing & Community Development Director � Andres Leza �� 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