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
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+�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�.
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�, Nam� of Cl�ir��nt: /'�ra�n C. r � �J. �.���° �
2. �4�clr���a �..�.� ��" �� ��
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Cwty: ����,�- r�Q' State• �� Zwp• �c��
3. Telephone Number: �� �� ��� `�° � '3�� _ �
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4. Date of Incider�t: �� ���
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5. T�me of Incid�rtta '� ��-3 C�.�a,
6. Lo��t6on c�f In�id�r�� ��e specific): �` ���e. /� f
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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�' � �
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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.)
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11. W�s anyone �njured? (If so, gove names, �ddress�:�, and extent of�njuries),
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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��`�''_
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13. What other d�rnages do you �9�irn, if any? ���a�
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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.)
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15, What �mou�t do you clarrr� fram ��� Cit�r of Dubuq�u�� Y�
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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�� ��,��
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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,) �
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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'? �
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�ated at �ubuq�t�, low�this �� d�� of %���'����, 20 /`�
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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
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TRACEY STECKLEIN g
PARALEGAL II
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To: Mayor Roy D. Buol and '
Members of the City Council� �
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DATE: March 18, 2019
RE: Claim Against the City of Dubuque by Francis J. Ward '�
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Claimant Date of Claim Date of Loss Nature of Clairn
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Francis J. Ward- 03/18/19 02/24/19 Vehicle Damage �
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�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. �
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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 �
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� John Klostermann, Public Works Director ��
Francis J. Ward �
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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