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Claim by Steven Mai Copyrighted September 21, 2020 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: Lisa Kramer for vehicle damage, Steven Mai for property damage / personal injury. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Claim by Lisa Kramer Supporting Documentation Claim by Steven Mai Supporting Documentation � ,� ��"'/ � CLAIM AGAINST THE CITY OF DUBUQUE, IOWA � This written report constitutes your claim against the City of Dubuque, lowa. 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. 13t" St., Dubuque, IA 52001. It � will then be referred by the City Council to the appropriate department for investigation. �i 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 li AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. � 1. Name of Claimant: Steven J. Mai � i 2. Address: 2592 Hilton Springs Dr. ! % City: Dubuque State: �owa Zip; 52002 � �i 3. Telephone Number: 563-585-1548 � � 4. Date of Incident: 31 May 2020 � ;� 5. Time of Incident: 10:30 A.M. i� �� 6. Location of Incident (Be specific): NW Arterial Bike Trail approximately 1/8 mile North/East of Red Robin, low lying area before uphill portion headed towards JFK Road. � 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give f�ll d�t�il� �ap�n v�hi�h you ba��e yo�ar clairne If � �ity erriployee wa� involved9 give the �i employee's name.) � City has been aware of drainage issues along this section of the bike path since at least fall 2019. Construction barricades were on-site for multiple months with no attempt to repair. 8. What were weather conditions like? 60 degrees, Sunny day, no rain the day prior (May 30) 9. Give name and address of any witnesses: No Witness 10. Did police investigate? (If so, give names of officers.) No Investigation 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). I sustained multiple abrasions from a fall onto my right side, I was prescribed an anti-biotic and tetanus booster from mv PCP due to an infection of the wounds on my leg and hip. � � � � , , � I i 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.) My bicycle sustained damage to the front fork (right side), tire and the rear derailure (right side), I I;; �� , also needed to purchase a new helmet as it was visibly damaged on the right side by my temple. �; � 13. What other damages do you claim, if any? No damages besides bike repair and medical �a , bills. � ; 14. Have you been compensated for any part or all of your claim by any insurance ,i company? (If so, give name and address of insurance company and amount paid.) ', ; �� No j; 'i �i 15. What amount do you claim from the City of Dubuque? 'ij Total $715.16 (Doctor Bill $125.08, Bicycle World $590.08) ',) 16. Why do you claim the City of Dubuque is responsible? 'i Negliaence through inaction to repair a known drainaqe issue in a timelv manner ', 17. Have you made any claim against anyone else for damages as a result of this incident? I��,i (If yes, give name and address.) Ij No I, i 18. If the answer to Question 17 is yes, have you received any payment from that source, i and if so, in what amount? ' N/A �I' � �� I! Dated at Dubuque, lowa this �� day of September 9 20 20 �Is ; � �t�-�' • ��'-'-�' (Signature) � � � Steven J. Mai (Print Name) � � � � `;�``` � � ' � � `� � � � � � � (Rev. 5/18) � cn � � � � _ :� �' � � .�, � � � � Confidential This communication and any attachments may contain information which is confidential and privileged by law and is for the use of the designated recipient. If you are not the intended recipient, you are hereby notified that you have received this communication in error, and that any review, disclosure, dissemination, distribution or copying of its contents is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of your receipt of these items and destroy the communication and any attachments immediately. Further disclosure of this information may violate state and federal restrictions. Confidential information may include the following: 1) Social Security Number(s) 2) Medical/Health Information 3) Personnel/Disciplinary Information 4) Bank Account Information 5) Financial Information 6) Credit Card Numbers If any documentation you desire to submit to the City of Dubuque contains any of the items above this cover sheet must be attached directly to the confidential information and indicate the type of information that is included. I, Steven J. Mai , hereby certify that the attached documents include the following protected information: Social Security Number(s) Bank Account Information X Medical/Health Information Financial Information Personnel/Disciplinary Information Credit Card Number(s) I understand that this information may be distributed within the City organization or to agents of the City for processing and I hereby authorize the City to act accordingly taking all precautions to protect my information from unnecessary distribution. S��-�'� • �� 9-11-2020 Signature Date � Kevin Firnstahl From: Steven Mai <maistevenj@gmail.com> �, Sent: Friday, September 11, 2020 12:35 PM � To: Kevin Firnstahl;Trish Gleason Subject: Claim Against the City of Dubuque by Steven Mai Attachments: Claimform_CityOfDubuque Master_StevenMai2020.pdf; BikeAccidentPictures.pdf; � BikeRepair.pdf; DrVisitSummary.pdf; DrBill.pdf Piease find the attached claim form and 4 additional files (Pictures, Doctor Visit, Doctor Bill, Bil<e Repair Bill) pertaining ;� to a bicycle accident which occurred along the Northwest Arterial bike trail on 31 May 2020. I have received ;� confirmation from Kerry Bradley in the Park Department that the area in which I was injured has been repaired (Citizen ,I Support Center Service Request W184490-072420), unfortunately I feel this solution was not implemented in a timely d manner causing personal injury and property damage. Therefore, I respectfully request re-reimbursement. l �I Sincerely, �l Steven J. Mai j1 2592 Hilton Springs Dr. Dubuque, lowa 52002 ! 563-585-1548 ii li Click i�' � https://www.mailcontrol.com/sr/cuGOKt4yyvTWQxILzJ5p9xHalEpBVH00rVoK9CTeDHXUfGfKo268Ke0mzUXm6lpSxT3xc4 � DNCK9JIvhZuck2lg== to report this email as spam. y i� h �i y � � �� ; 1 1 � � � 1 i � � Copyrighted September 21, 2020 City of Dubuque Consent Items # 3. City Council Meeting ITEM TITLE: Disposition of Claims SUMMARY: CityAttorneyadvising thatthe following claims have been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool: Lisa Kramer for vehicle damage, and Steven Mai for personal injury/ property damage. SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description Type I CAP Referrals Staff Memo Dubuque THE CITY OF � All•AOerica Ciqt DuB E .,,��,,�rx�j,..� 1 ' I � I�/ Maste iece on the Mississi i zoo�•Zoiz•zoi3 � pp zoi�*Zoi9 TRACEY STECKLEIN - .�C�' PARALEGAL MEMO To: Mayor Roy D. Buol and Members of the City Council DATE: September 11, 2020 RE: Claim Against the City of Dubuque by Steven J. Mai Claimant Date of Claim Date of Loss Nature of Claim Steven J. Mai 09/11/20 05/31/20 Personal Injury/ Property Damage This is a claim in which claimant alleges that he was injured and his bike was damaged while riding on the Northwest Arterial bike path. Claimant states that the incident was caused by drainage issues. This claim has been referred to the lowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager Marie Ware, Leisure Services Manager Steven J. Mai OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR�/IEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563)583-4113/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org