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Claim by Wade Duncan Copyrighted April 1 , 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUM MARY: Adrian Appelman for property damage, Wade Duncan for vehicle damage, C. Dennis Gansemer for vehicle damage, Donna Sindahl for vehicle damage. Francis J. Ward for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Appelman Claim Supporting Documentation Duncan Claim Supporting Documentation Gansemer Claim Supporting Documentation Sindahl Claim Supporting Documentation Ward Claim Supporting Documentation CLAIM AGAINST THE CITY OF DUBUQUE, IOWA This written report constitutes your claim against the City of Dubuque, lowa. You should 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. 13'" St., Dubuque, IA 52001. It witli then be referred by the City Council to the appropriate department for investigation. Once that investigation is completed, a �eport and recommendation will be submitted to the City Council. You will be provided with a copy of that report and recommendation. THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM ILL OR WILL NOT BE PAID. 1. Name of Claimant: _ (/��/L� �„i�,y�.�/ 2. Address: /D// Uk ��c y ✓�w �i' City: C��.^��5s�z� State: �� Zip: -s.�� 3. Telephone Number. � J�' � �5 j � �t//,� 4. Date of Incident: _i7 �L�/�j i 5. Time of Incident � ." �,3 6. Location of Incident (Be specific): __ � �y/ %�e l,f � �/ ��f� ��k� � — 1 )�I�JSdE /1�" � 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. If a City employee was involved, give the e/m�ployee's name.) (�/r�/CA-- /ala� or y �I�er./�ifR,4'l� /> � �/✓tr f�c �/do/� G'.��0 9 l F� O 4"F ��w �JiiYO/� 8. What were weather conditions like? `i �CAr �/p �,,,f G✓�q �� /' 9. Give name and address of any witnesses: /" G /��t— �� 10. Did police investigate? Qf so, give names of officers.) � (I,fSc �l o��icc� ��r�,.� ��n.;�� 13�� e �/o l, � „?al9 -aol�rz� 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). /l/D i 'I�. VVa� ar�y c��mage ��rr� t� rc� ert � � � R 7�. �ff s�, d�scr��i� pr�p�rty a�d #�� ex�er�� o� � c1��ges. Atta�h ��fi�mat�s r�f `r��mac�e� or d��cribe ��s�s f�i� ��ce�tain�n� ��t�n� of ' d�t�r�c��.� _ �� ,, � `�"�i�t`��',.�„�'sr�� °° ��s�' �,�� r� ` � +� ��7� ��-�,t�f�1/` ' ; 1�, 'Vtlhat c�ther c��ma e� d�i rt�u cla� ' � � r�, t��ny'? 9 �I j '�4�. Haue ytru k��er� �r�r��t��a�ed fc�r a�y ,��rt �r a�l c�f �c��ur c1�im t�y a�ny in��r�rr�e � � �crrr�p�r�y'? (�f s�a, �ave n�rne,�nd ad�tr��s �sf irt��r�� c�rrrt�any and �mout�� ;� �I ; � � 1�. 1111hat'��m�aunt�Ic�yc�u� ct�imi �r€�m the �ity ��C��zk��c�u�� r� ��,�� il � ,�r� �`��'�r..- �i`�� ,_ �.,�` �,�-h, � �, 1�. ��y t�o y�u �I�irr� tF�� City c��bub�c�u� i� resp�€�n�i��'� „ � �- � �' .�1 �� t f.�` ��. ��`��,� �; � '�7f H�ve�rc�u m�de �r�y cl�im aga�r�s� ar��r�n� ��e fc�r c��mac�� r�sutt c��this ir�cicte��? � {if�e�� ve na�me�r�d act�re�s.} � � 1�. 1f �� r�sv�r�r t€� �t�e��ior� 1T is y��; �ave yc��z r�c�iv�d �r�y payme�� frc�tr� th�t ��rc�; � anc! i�f,�o, in rrvhat a�c�un��` II I il � C��t�� t t�c�buq��, 1��sra this d�y af__ .��`�°,� 2��. � � � _. (S�igna�r�r�� {Pr�r�t Name} � � �� 4.��= � � �Rev, �f78} � � � � _�a �;- � �`� � c�` ..�, � �� :. � �- 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 inCended 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)-589-4'120 of your receipt of these items and destroy the communication and any attachments immediately. Further disclosure of this information may violate state and federal restric[ions. Confidential information may include the following: 1) Social Security Number(s) 2) Medical/Health Information 3) Personnel/Disciplinary Information 4) BankAccountlnformation 5) Financial Information 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, F�� ✓,�c,,,.J , hereby certify that the attached documents include the following protected information: _Social Security Number(s) _Bank Account Information _Medicai/Health Information _Financial Information _PersonneUDisciplinary Information _Credit Card Number(s) I understand that this information may be distributed within the City organization or to agents of the City for processing and I hereby authorize the City to act accordingly taking all precautions to protect y infor i n from unnecessary distribution. �� 3�/S- �� Signature Date Copyrighted April 1 , 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:Adrian Appelman for property damage, Wade Duncan for vehicle damage, Francis J. Ward for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo TH6 CTTY C7F I� LT� E MEMORANDUM � �Masterpiece on the Mississippi � s TRACEY STECKLEIN � PARALEGAL � I, To: Ma or Ro D. Buol and � Y Y Members of the City Council ;� , DATE: March 21, 2019 RE: Claim Against the City of Dubuque by Wade Duncan � � �� Claimant Date of Claim Date of Loss Nature of Claim ;i � ,; Wade Duncan 03/20/19 03/12/19 Vehicle Damage ;� ,a This is a claim in which claimant alleges that his vehicle which was parked on Clark Drive �' near the intersection of Clarke Crest was struck by a City of Dubuque Jule bus. ;; �: '�; This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa I�; Communities Assurance PooL � � cc: Michael C. Van Milligen, City Manager N Russ Stecklein, Transportation Field Services Manager p 1Nade Duncan � , fi � � � �� 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