Claim by Sherrie Moriarity Copyrighted
May 20, 2019
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Shannon Katka for personal injury/vehicle damage, Jordan
Lyons for vehicle damage, Sherrie Moriarity for vehicle
damage, Linda Rauen for vehicle damage, Kimberly
Sampson for vehicle damage
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City
Attorney
ATTACHMENTS:
Description Type
Claim by Shannon Ketka Supporting Documentation
Claim by Jordan Lyons Supporting Documentation
Claim by Sherrie Moriarity Supporting Documentation
Claim by Linda Rauen Supporting Documentation
Claim by Kimberly Sampson Supporting Documentation
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�:Ll�l�� J�l .�71����� ��� �:��� �}F DUB�Q��i �Q�t� ��1 tt C��.. .
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This writ�en repar� canstitufies your claim agairrst the Cifiy of Dubu+que, lawa. You shauld
, complete this farrn irt full and attach any additional infarrnatio� that suppc�rts your cl�rim.
Th� Cl�im mu�t b� filed verifih the Cifiy Clerk at ��ty Hall, �tI W. ����' St., C�ubuque, IA a�00'1. It
wili then be referred by th� Caty Counci! to the appropria�e department f�r investigation,
{)nce that inve�tigatian is c�mplefied, a report and recommendat�an will be �ubmi�ted ta th�
C��Ly Councii. You will be prov�d+�d with a cc�py of that rep�rt and recammend�t�on.
THE FINAL DIECIS1t7N t�N ALL CLAIMS IS MADE BY THE C[7Y CtJUNCIl.. NC3 EMPC.{�Y�E O�
THE CITY QF DU�UQUE HAS THE AUTH{�RITY TCl MAl�E A�iY RERRESENTATI(]N TC} YQU
AS TCJ WH�TH�R Y�}U�i GLAliVf WiLL �►R '�'VILL Nt3T BE PA1D.
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'1. Name of Cfa�manfi. �=
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2. /�►ddre��. �� � �� l� � �;
Cify.��,��;� �fi���. ���-�,�.�� �ip: �.�"�'�"��-� �
3. Telephone �e�mber: � Cr�.�
4. Date of Incident: ���'�- �' ;
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�. Time t�f I�cid+�nt. �t� �' 1
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6. Loc�tit�n af Inciden���e specific�: � u' �� ..�i��-
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?. E�E�CRI�E AC��L�ENT OR t'�CCURRENCE THAT CAUSEC� 1N,�URY t)R Q►AMACE. (Give !i
fuil d�fa�ls upon whi+�h you base �rour cCaAm. If a Ci�y �mpioyee v�ra� in�ralved, give #.he
emplayee's name.)
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e� � ����� S'���. �t���'� ��---
�. What were weather conditions like? �t.r.��,��
9. Give name and addres� of any witne�ses.
�0. Did p4tice inv��tig t�? (1f so, gi�re n�r�es of t�f�icers.)
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l�� �� ��� -� �'���'— � � -- �L� �� �'"��"'
'I'!. 'U6►as anyc�ne injured'� �If sc�, give narne�, addresses, and exkent of �njuries�.
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12. Was any damage done to property? (If sc�, d��cribe prop�rly and the extertt of
, damag�s. Afifiach est�ra�ates �f damag�s or des�ribe basis far a�cerf�ining extent of
damage.�
���� ��G`� �'Ll 5'�r��� �`�'�.�'� ��� �'l�f� 1��� ./� � �� ---"`
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13. What o#her damages do you c1a�m, if ar�y? ���rt��--
14. Have you been compensated for any pa�t ar a�l c�f your �laim by a�n� in�urance
comp�ny? {lf so, give name and address of insurance company� and amc�unt paid.)
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'1�, Wh�#amount��� claim fr .�m th���ty +�f Dubut�ue?
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�16, �y do y��t.�cl�airn th�ity of��abuque i� r�spar�sib�e?'
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'17. Have yo+u made any cla�m �gai�st �nyone else for dama�es as a r��ult af this in�cid�nt2
(lf yes, give name nd addr�s�.}
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�1�, If the answer to t�uestion 17 is yes, h�ve you received any payment from that source, I
�nd if�o, 6n what arraaun#?
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��ted at Dub�aque, lowa this �`� day af
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This communicatit�n and any atta�chmer�ts may contain informa�ian which is canfid�ntial �
� and privileged b� law and is far the use of the de�i�nat�d recipi�nt. If you are not the �
Nnt�nded recipien�, you are hereby noti#ied �hat yo� have received this c+�mmunic�fion in �
error, and that any review, di�closure, di�semination, distributic�n Qr�opying af its �ont+��#s �
Ns prohibit�d. Pl�a�e notify Gity of Dubuque immedi�fiety by #el�phone at {583}��89-4120 0� �
your r+e�eipt r�f these item� anct d�stroy the communi�c�t�on and any �tta�hmenl�s :j
immedia#ely. Further disclosure of this inforrna#ion m�ry violate si:afi� and federal i
re�trictions.
Confidential i�f�rm�tion may include the follawing:
�
1} Soci�l Security �lumber{s} '�
2) Mec�icallHealth Informatic�� `
�) Perst�nnellDisciplinary Informatian '
4� B�n#c Account Inform�tion �
5) Finar�ciaf �nfc�r�at6c�r� ;
�) Credit Card Numbers
�f any dac�mentati�n yc�u desire to s�abmit to the �ity of Dub�qu� cor�tains any o�the items abave
thi� c�ver �heefi m�ast be atta�hed directly to the ct�n�d�ntiaf infarmati�n and indicate the type �f '
onformat�Qn that is inc�uded.
i
I, /� � �''>/��'�1 , hereby certiify that the attached dacuments
include the fol#owin� protected r�formation;
Social Sec�arity t�umber�s) ��ank Account �nformati�r�
Medical/Heal#h lnfor�nat�on Fin�ncial Informatian
�Persc�nnellDiscipiinary Infar�ation Credit Card �lumber(s}
� under�fiand that this infc�rmatic�n m�y be di��ributed w�fihin the Gity �rganizatic�n or ta agents af the
�ity for pro�essin� and f hereby authorize the Gity to act accordingly ta�ing al1 precautic�ns t�
pr4tect my informatia�n from unnecessar}r di�tr'rbutian.
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� wgn�ture ��te
Copyrighted
May 20, 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: Shannon Katka
for personal injury/vehicle damage, Jordan Lyons for
vehicle damage, Sherrie Moriarity for vehicle damage,
Linda Rauen for vehicle damage, Kimberly Sampson for
vehicle damage
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Supporting Documentation
THE CIT'Y OF
L�� � MEMORANDUM
Master�aiece on tl�e Mississippi
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TRACEY STECKLEIN �
PARALEGAL
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To: Mayor Roy D. Buol and
Members of the City Council p
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DATE: May 6, 2019 �
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RE: Claim Against the City of Dubuque by Sherrie Moriarity �
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Claimant Date of Claim Date of Loss Nature of Claim ��
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Sherrie Moriarity 05/06/19 04/29/19 Vehicle Damage �!
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This is a claim in which claimant alleges that her vehicle which was parked on James ��:�
Street was struck by a City of Dubuque Jule bus. ;
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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
Russ Stecklein, Transportation Services Field Operations Supervisor �
Sherrie Moriarity II
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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/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org