Claim by State Farm Insurance_PizzimentiTHE CITY OF
DUI1 t LJE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
4
To: Mayor Roy D. Buol and
Members of the City Council
DATE: March 30, 2010
RE: Claim Against the City of Dubuque by State Farm Insurance, subrogating
for Marco Pizzimenti
Claimant Date of Claim Date of Loss Nature of Claim
State Farm Insurance 03/12/10 01/23/10 Personal Injury/
Vehicle Damage
This is a claim in which claimant alleges that its insured's vehicle was involved in an
accident at the intersection of Central Avenue and 5 Street. At the time of this
accident, the stop lights were non - functioning and a portable stop sign was temporarily
being used on 5 Street, but was obscured from view due to a parked vehicle.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Mark Dalsing, Chief of Police
State Farm Insurance
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001 -6944
TELEPHONE (563) 583 -4113 / FAx (563) 583 -1040 / EMAIL tsteckle @cityofdubuque.org
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. 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 West 13` St., Dubuque, IA 52001. It will then be referred to
the appropriate department for investigation and to the City Attorney's Office. Once that investigation is completed, a
report 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 will or will not be paid.
1. Name of Claimant: �et. e fares h sur4n C d
2. Address:
Po Igo x 1 3J0‘ L:`n g.o /.7 , -/l/E (50/
3. Telephone Number: ++ / S - 94 , ‘ .Z-
4. Date of Incident: I O3 —/Q
5. Time of Incident: 7 ( V7 4z/
6. Location of Incident (Be specific): C e ri Y a / v C g
7. Describe the accident or occurrence that caused injury or damage. (Give full details upon which you base your
claim. If a City employee was involved, give e employee's name.)
5 e . 1° ol,�"et chi -e give
po. a
8. What were weather conditions like? /1 a k rr i, /
9. Give name and address of any witnesses: 5 e-e- rki
10. Did police investigate? (If so, give names of officers.)
e
11. Was anyone injured? (If so, give names, addresses, and extent of injuries.)
ye- � , / lf ► c.e r 546N e r /
Ao iIlc j�✓ur ?t Lrr!i kP "Ailed/
12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of
damages or describe basis for ascertaining extent of damage.)
5b; Chev Ue n d-u r e
clod l l'py o)'q /?A. if
F n 41 oa m.41e 4 mbai.✓►.t
13. What other damages do you claim, if any?
14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give name and
address of insurance company and amount paid.)
'Vq
15. What amount do you claim from the City of Dubuque? /ob Po V etli
16. Why do you claim the City of Dubuque is responsible? 5 / dP 5 I (f
17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and
address.)
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated this Jo)" day of Mar c/1
,It&
(Signature)
R D n X./ e ;
(Print Name)
SJ'a e_ Farms
,20
1J03
1635o S k0
Iowa REPORTS TO:
Ol s of Driver
r S d ices Transportation
OrinLIIII
Carols d Driver Services
D, oes
Dess Moines,
Fwa 50308-9204
Iowa Department of Transportation
INVESTIGATING OFFICERS REPORT OF
MOTOR VEHICLE ACCIDENT
Levi Effacement Case Number
01-10-3256
L
0
c
A
T
0
N
Date of Accident
01123/2010
Tyne of Accident
09:47 Its.
County
Dubuque - 31
Accident ocarred wdhln corporate boils or OM
Dubuque-2100
Legal Private
btervenitOn711 Property' 0
If accident occurred outside of ay lints
shoe genera "NIA"
of nearest city "N/A"
On Rood, Street, or highway.
CENTRAL AVE
Al Iserseclion war
5TH ST
Noss: Unless accident occurred et en intersection which Is completely described above, use the specs bebw to give the exact
loci/Ion from, mtkpdet « dslkreble'riterseabr>, bridge, or railroad crossing, using Iwo distances end dFectam if necessary.
Location Literal Description
W 5TH ST and CENTRAL AVE
Distance
"NIA"
Dkealon
"N/A"
Distance
erg "NIA"
Direction
"N/A"
of
a -Coordinate: 00691968
YCoardnele: 04707629
Milepost Number Definable intersection, bridge, or railroad awing
"NIA" Or "NIA"
N DMded Highway. Provide Roues
t Cardinal) Travel Demotion
U
N
T
001
Orlrars Name - Last
RIVARD
Address
964 ELM AVE
First
THERESA
Drivers License Number
City
WINDSOR
Gender
Female
State Class
ON G
Endorsements Resuktiaa
NONE NONE
Alcohol Teal
Given?
1-None
Test Results:
Plug Test
Given?
1-Nome
Test Results:
MidM
MARIE
Citation Charge Code 1
321.322
C talton Charge Code 2
Citation Charge Cod 3
Citation Charge Cod 4
Suito Hama&Cell Phone
(519) 251.1606 x
State
ON
Cdalion Charge 1
STOP SION VIOLATION
Citation Charge 2
Cdation Verge 3
Carson Charge 4
21P
N9A5H-3
Seating Position 01
Injury Sinus 6
Occupant Proteclbn2
AStag Depbtment 5
Midas Swtai Stabs 3 !Election 1
E7a5011 Pqh 1
Trapped 1
Tra sport d to:
Trrrsported by.
Owners Name - Lest
PIZZIMENT1
First RCO
ANTHONYA
Sulfa
Choler Company Nome
Address
6 JEENSEN CT
Irrnrrtce Ca None
STATE FARM MUTUAL
YIN Na
10MDX03E21022028a
Year
2001
Make
Chevrc(N•CHEV
IOWA�CITY
Insurance P 4
2645341D1115D
model
VEN
State
IA
Initial Travel
Dhedbn 4
Total
OaagW.i 3
Vehicle 01
Traffic
Controls 04
1%41 25
I W of
Impact 02
Vs**
GaAs 03
Type Body 01
Most Damaged
Area 02
Vehicle
Defeo 01
Extent of
Damage 4
Driver
Condition 1
Underridd
Ovenke 1
Vision
Ob,arsd 07
BEOUENCE OF EVENTS I Fur Ewe 21 Second Event Third Event Fourth Ewalt
Commercial Trder Attached le
License Plate a Pow Unt:
Stele Year niched to
Trader Unit
Z5T246
License Plate N
419JJA
Tow
YES
Prairie? ❑
Slate
IA
Year
2010
Approximate Cost to
Repair or Replace
54,000.00
Core:Wang Granatances,
Dever top so two) 02
Meet Nanmkj Even (by vehicle) 21
Stele Year
Emergency
Vv4de Type 1
Emergency
Status 3
Caviar Name
Address
City
Stale hip
US00TI or MC
Number of
Ades
Grass Vehicle
Weigh Rating
Placard r
Hazardous Materials
Reaased7
U
N
002
O044 r, Name - Last
KENNEDY
Address
2905 JACKSON ST
Rat
NICOLE
Dale of Birth Drivers License Number
Gerdes Sloss
Female b4
Coss
C
Alcohol Teal
Divan? Test Results:
1 -Nore
City
DUI3UQUE
Erdorsemental Restrictions
NONE NONE
Drug Teat
Oven?
1 - None
Test Results.
bocce
AMBER
C anion Charge Coda 1
Gt.Lon Charge Code 2
Citation Verge Cod 3
Coal m Crams Cod 4
Sutra HpnwCCeN Phase
(910) 361-7474 x
State
IA
Citation Charge 1
Citation Charge 2
Gtaticn Charge 3
Citation Chaise 4
Zip
52001.3000
Sealing Position 01
Injury Status 4
Occupant Proleclion2
Airbag Deployment 6
Airbag Swtch Status 3
Ejection Path 1
Trapped 1
Transported to
Transported by
Owners Name - last
KENNEDY
Airst
NTHONY
GI ED ON
Salk
Owner Company Name
Address
2905 JACKSON ST
Insurance Co. Name
UNITED SERVICES AUTO
Cq
DUBUQUE
Insurance Policy i
01872 7617U
State
IA
62001
License PWe N
7e1SLC
Sate
IA
Year
2010
VN No.
JTE10H2OVe1002e223
Yost
2001
Make
Toyota - TOYT
Modal
RAV4
Style
4DR
Initial Travel
Direction 3
Total
Ocatpanls 2
Vehicle
Acton 01
Traffic
Contrda 01
Urns 25
Pant of
attest Impact 01
Vehicle
Conrlg. 04
Cargo Body
Type 01
Most Damaged
Area 01
Vehicle
Defect 01
Extent of
Damage 4
Drier
Condition 1
Union -kW
Override 1
vision
Obscured 01
Tow 4
YES
Private? ❑
Approximate Cost I
Repel « Replace
11,000.00
Conunburrg Cramatamps,
Or yr (up to two) 26
SEQUENCE OF EVENTS I Firet Evart 21 Second Event ilird Event Fouts Event
Alen Harmed Event (by viatica) 21
Commie Troller Attached to Sole Year Attached to
License Plate a Poorer Unk Tndtar Unit
Stare Year
Ernergency
Vehicle Type 1
Emergency
Stead 3
Carlin Name
Address
City
State
Zip
US DOT I or MC
Number of
Axles
(oast Vehicle
Weight Rating
Placard e
Hazardous Matenlle
Released?
Printed At Dubuque Pollee Department 01124I201011:13 AM
Page 1
Form M:01.10.3256
ACCIDENT ENVIRONMENT
Location ol Fke1 Harmful Event 1 Weather Cenadons
Manner of CredYCo/sion S Ito to taro) 03
UV Conditions 1 Suisse Conditions 2
ROADYJAYCHARACTERISTICS
Mates Cofltbulhg Cira+mstances:
Environment 1
Rosoway 08
Type of Roadway AaxyionfFesere 11
WORKZONERELATED/
No
Location
Type
Workers Present?
SEQUENCE OF EVENTS
Fist Harmful Event cf Cram
(use codes 1142 only) 21
5TH ST
jV1
2
LEGALLYIARKED
VENICIE
CENTRAL AVE
,'
1
NARRATIVE
Owns what happened (rata to vehicles by munber)
UNIT #2 WAS SIB ON CENTRAL AVE AT THE INTERSECTION WITH 5TH ST. UNIT #1 WAS WB ON 5TH ST AT THE
INTERSECTION WITH CENTRAL AVE. DRIVER OF UNIT #1 DID NOT SEE THE STOP SIGN AND ENTERED THE
INTERSECTION WITHOUT STOPPING AND STRUCK UNIT #2 BROADSIDE.
THIS INTERSECTION IS NORMALLY A 4 -WAY STOP CONTROLED BY STOP LIGHTS IN ALL DIRECTIONS, THE STOP
LIGHTS WERE NON- FUNCTIONING AT THIS TIME DUE TO BEING REPLACED. BECAUSE OF THESE CIRCUMSTANCES,
THERE WERE PORTABLE STOP SIGNS IN PLACE FOR E/B AND WB TRAFFIC ON 5TH ST BUT NO TRAFFIC CONTROL
DEVICES FOR SIB TRAFFIC ON CENTRAL AVE.
DRIVER OF UNIT #1 STATED THAT SHE DID NOT SEE THE STOP SIGN DUE TO A TRUCK BEING PARKED IN FRONT OF IT
AND BLOCKING IT FROM HER VIEW. R/0 DID OBSERVE THIS AND DETERMINED THAT THE TRUCK WAS LEGALLY
PARKED BUT DID OBSCURE THE STOP SIGN FROM VIEW OF WB TRAFFIC. THE STOP SIGN WAS ALSO PROPERLY
PLACED FACING WB TRAFFIC AND WAS SITTING AGAINST THE CURB LINE. IT APPEARS THAT THE STOP SIGN BEING
OBSCURED WAS MAINLY DUE TO THE SIZE OF THE TRUCK (FULL SIZE TOYOTA TUNDRA) AND THE HEIGTH OF THE
STOP SIGN.
WlesaName - last Fist WM.
8uYu
SANNER JOHN
Address
Ciy 5Iate Zip Cede
3814 CORA
DUBUQUE IA 62001
Horne/Cell Phone 11
Work Phone •
(563) 543 x
Officer
Badge No.
Time Maw Notified of Accident Time Weer Arrived AI Scans
HOERNER JASON
51
08;47 Hre 09:50 We.
Name of Agency
Otte of Report
knahgetion
T.I.1
Dubuque Pollee a Dope
0112312010
mode et sane? Yee
Report Reviewed By: � s1/ l C #
O
l ipar
Deter ToarIk Investigation Agency
Printed At Dubuque Police Department 01124/201011:13 AM
Page 2 Form it 01-10-3256
State Farm Insurance Companies
March 10, 2010
City Of Dubuque -City Clerk
City Hall 50 West 13th St
Dubuque, IA 52001
RE:
Claim Number: 15- 3504 -580
Date of Loss: January 23, 2010
Our Insured: Marco Pizzimenti
Dear City Clerk /Claims:
Enclosed is a claim form against the city of Dubuque and
a corresponding police report. A temporary stop sign
was placed at the intersection of Central Avenue and
5th Street, however the sign was not visible due to a
legally parked truck. The city failed to put the sign
where it was visible in the intersection or block off
the parking spot the truck occupied so the sign could be
seen.
At this point, we do not know the extent of the claims
but will advise you when we have this information.
Please look into this matter and advise me on your
position of liability.
Thank you for your cooperation in this matter.
Sincerely,
�-d ► l
Ron Klein
Claim Representative
(515) 223 -9162
Toll Free: 1- 800 - 658 -3731 Ext: 2239162
State Farm Mutual Automobile Insurance Company
HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001
State Farm Insurance
PO Box 83106
Lincoln, NE 68501 -3106
Phone: (800) 658 -3731
Fax: (800) 423 0474