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Claim by Francis Ward 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 1 M M +�LAIM ACaAINS1' 1'HE �ITY OF DllBUQUE, IOWA �•�IL�"�"���n- This written report constitutes your �laim against the City of Dubuqtae, taw�. Ycau shou�d ccamplete this form 6n f�all and attach any additional information that suppor�s yo�ar claim. Th� Glaim musfi b� file�i wrth the City Clerk afi +�ity Hall, 5Q W. 13t" St., Dubu�que, IA 5�Q01. It wil� th�n be referred by the City Councii to the appropriate department fior investigatio�. Once that i�nvesti�ation is completed, a reporfi and recomm�ndation will be submitted ta the City Council. You will be provided vvith a cc�py of that report and recommendafiion. THE F1NAL �E�GI�IQN ON ALL CL.AIMS IS MADE BY THE CITY COUNCIL. NO EIVIPLCdYEE QiF THE CITY OF DU�UQUE HAS THE AUTHORITY TO MAKE r4NY REPRESENTATION �'O YC)U AS TO WHETH�R�'OUR CLp►IM WILL OR WILL NOT �E PAII�. � p �, Nam� of Cl�ir��nt: /'�ra�n C. r � �J. �.���° � 2. �4�clr���a �..�.� ��" �� �� � � � Cwty: ����,�- r�Q' State• �� Zwp• �c�� 3. Telephone Number: �� �� ��� `�° � '3�� _ � � � � 4. Date of Incider�t: �� ��� � 5. T�me of Incid�rtta '� ��-3 C�.�a, 6. Lo��t6on c�f In�id�r�� ��e specific): �` ���e. /� f J(-����� �, ���'�7��� �'' ���-�,� rr� ���1� �� '� _ 7. DE�CR.IBE A�CIDENT OR 4CCURRENCE TNAT �AtJSED IN�9�JR1( GR DANiA��. (Gioa� fiull det�ils upon which you base �/our cl�im. If a C�ity empioyee was i�volved, give fih� emplo�+ee's nam�.) �;�o� �'� �r,���t���. �"�1t�ral ,+�o�l� �"`��,,�� ��h�r� �er�-�' e,� � �� oc�' � � �'' �,�'°�"' J. � ..�'i �i;/� �2�a� �.n�_�—�e�s"�' A� � �nr V"��l� !C,/�' /��e ���/ ys �� �G°�� S°,,��'" �l'��t ,�`d�� �'"� -------� �E�t �r,,/ t G�lt�r,� �'i� ��'�t.��n �i e�'y �"`'��.z, r ei�� S°$'eaj� e �� ,r�,� �t't�°' �.h ;H °9 � �, q �✓ 8. Wha#were we�ther conditians like� � � �1� r�c�c.�r�- , ����6 .� s�rr.�„ �'l,°� J 9. Give name and �ddre�s of�ny witn+��se�: 10. Did p�iice investigate? (If�o, give name� of officers.) �,d ��.s` ���,c��,w ������ ���,���°, J��z� a- 11. W�s anyone �njured? (If so, gove names, �ddress�:�, and extent of�njuries), � � 12. Was any daimage done to pr�perty? (If sa, d�scribe property and fih� extent of damages. Attacti �stimates of damages or describe basis for ascertaining �xtent of damage.) �J�l,�-�h �-;�,r�r- 5',��� e�°°�t�- �,�,.i� /7���� ...�.� e�Je�-S 6h � �� f ����°'�..o��`�''_ � J ���� !�'� � I 13. What other d�rnages do you �9�irn, if any? ���a� � 14, Hav� you be�n comp�nsated for any p�rt or all of your clairn by any insurance �ompany? (Ifi�o, give n�me and address af insur�nc� comp�ny �nd arnou�t paid.) a � III r 15, What �mou�t do you clarrr� fram ��� Cit�r of Dubuq�u�� Y� � G �;' 16. Why do yc�u claim the�Crity of I�ubuqu� is r�spor��ib/le? /� � �/` /' � C.�a� � ��, te. a.L�'- f� /e�� �✓ y,..r°� �,°►,� Cc, C..ti� s����G.�" �'e4�� ��,�� f � �"- "'6��'�d f 17. Have you m�c�e any ct�im agair��t-anyone else for darnages as a w�:sult of thi� incid�nt? (If��s, giv� nam+� and address,) � C� � � � 1�. If the �nsw�r to Q�ae�tion 17 is ye�, have yQu rec�ived any payment firom th�t scrucce, ` a�d if so, in what a�mount'? � � �ated at �ubuq�t�, low�this �� d�� of %���'����, 20 /`� � i <<� � (Signature) ,���,�t ;�' ��-- �°��.�� (Prin� Name) � � � � y�`�'� � �° � �� � � I � E�� � � Rev. 5/18 -� �m � ( ) � c�� � s.� �. �� �' � � �� �� �� 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 THE CITY OF L.wJ � �.J La � � � 0 1� � 1 \ � V � Mc�ste7�piece an tl�e Mxssissippi a �� � TRACEY STECKLEIN g PARALEGAL II ; � N; �� i To: Mayor Roy D. Buol and ' Members of the City Council� � I� � DATE: March 18, 2019 RE: Claim Against the City of Dubuque by Francis J. Ward '� ; ;I Claimant Date of Claim Date of Loss Nature of Clairn 'i Francis J. Ward- 03/18/19 02/24/19 Vehicle Damage � ; �fhis is a claim in which claimant alleges that his vehicle which was parked near 3079 Spring Valley Road was struck by a City of Dubuque snow plow truck. � i This claim has been referred to Public Entity Ftisk Services of lowa, the agent for the lowa j Communities Assurance Pool. � cc: Michael C. Van Milligen, City Mana er � 9 � John Klostermann, Public Works Director �� Francis J. Ward � ;� � � OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/F,vc (563)583-1040/EMai� tsteckle@cityofdubuque.org