Claim by Brien MohlisCopyrighted
April 20, 2020
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Tanya Anglin for personal injury, Brien Mohlis for vehicle
damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City
Attorney
ATTACHMENTS:
Description Type
Claim by Tanya Anglin Supporting Documentation
Claim by Brien Mohlis Supporting Documentation
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ?), v1/
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 W. 13th St., Dubuque, IA 52001. It
will then be referred by the City Council to the appropriate department for investigation.
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.
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1. Name of Claimant:
2. Address: ,1316 Do ()-, Ave,
City: )-1-)con k State: 9
3. Telephone Number: '5 (2 ` 6 0 ? q /
4. Date of Incident: ,q• $ -
5. Time of Incident:.
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Location of Incident (Be specific): /225 PJ
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
employee's name.)
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8. What were weather conditions like? (2,),(,,tt,, \�,,,, k,,,,) 7} rs. L�-- e., ►, pti.,i , PrA>,,,
9. Give name and address of any witnesses: p n �.
10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.)
13. What other damages do you claim, if any? ATO
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.)
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15. What amount do you claim from the City of Dubuque?
16./�lWhy do you clai the Cit of Dubuque is responsib e?
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, giyp 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 at Dubuque, Iowa this r,?2 day of (/ ► ►c 'v
Ern l)(-)
(Rev. 5/18)
, 2oO
(Signature)
(Print Name)
Copyrighted
April 20, 2020
City of Dubuque Consent Items # 3.
ITEM TITLE: Disposition of Claims
SUMMARY: City Attorney advising that the following claims have been
referred to Public Entity Risk Services of Iowa, the agent
for the Iowa Communities Assurance Pool: Tanya Anglin
for personal injury and Brien Mohlis for vehicle damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
I CAP Referrals Staff Memo
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MEMO
To: Mayor Roy D. Buol and
Members of the City Council
DATE: April 6, 2020
RE: Claim Against the City of Dubuque by Brien K. Mohlis
Claimant Date of Claim Date of Loss Nature of Claim
Brien K. Mohlis 04/03/20 03/18/20 Vehicle Damage
This is a claim in which claimant alleges that his vehicle which was parked near 1775
Palm Court was struck by a City of Dubuque recycle truck.
Dubuque
AII•Ameriea City
NAPCNALCM IJ *)n
2007*2012*2013
2017*2019
This claim has been referred to the Iowa Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
John Klostermann, Public Works Director
Brien K. Mohlis
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