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Claim by Jacob Schlosser
Copyrig hted March 1, 2021 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: 2G2, LLC. for breach of lease;Asbury Square LLC for property damage; Jackie Jones for property damage; additional claim information from Ronald Koehler for property damage;Aaron Rang for vehicle damage; Jacob Schlosser for property damage; additional claim information from State Farm a/s/o Michael or Jennifer Connolly for property damage. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Claim by 2G2, LLC Supporting Documentation Claim by Asbury Square LLC Supporting Documentation Claim by Jackie Jones Supporting Documentation Additional Claim Information by Ronald Koehler Supporting Documentation Claim by Aaron Rang Supporting Documentation Claim by Jacob Schlosser Supporting Documentation Additional Claim Information by State Farm a/s/o Supporting Documentation Michael or Jennifer Connolly VVI 1. IVIVJJVIIVII MVM CLAIM AGAINST THE CITY OF DUBUQUE, IOWA J. Klostermann 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. 13t" 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 CLAII�IWILL aCO�R �Ll- il IoSser 1. Name of Claimant: ��,„JJ 2. Address: 493 Lowell St. City: Dubuque State: I .A. Zip: 52001 _ 3. Telephone Number: (520)904-4044 4. Date of Incident: January 20, 2021 5. Time of Incident: 3:50pm 6. Location of Incident (Be specific): Corner of Gold St. and Merchants LN. 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.) �As I was driving down Gold St. I turned to go down Merchants Ln. where my front right tire suddenly fell through the street, followed by back right tire. 8. What were weather conditions like? Below Freezing tempetures 9. Give name and address of any witnesses: N/A 10. Did police investigate? (If so, give names of officers.) No 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). No 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 vehicle sustained physical damage to the front lower bumper cover and now needs a front end alignment 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.) No 15. What amount do you claim from the City of Dubuque? $817 (For replacement bumper cover and front end alignment) 16. Whv do you claim the Citv of Dubuaue is responsible? The City'of Dubuque should be responsible for the conditions of it's roads so as not to result in property aamage. 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) No 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? N/ Dated at Dubuque, Iowa this 11 day of _January Jacob Schlosser (Rev. 5/18) 2o, 21 (Signature) (Print Name) Received email 2/11/21 @ 7:22 p.m. Processed on 2/12/21 @ 8:05 a.m. /s/lrish GCeason 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, , hereby certify that the attached documents include the following protected information: Social Security Number(s) Bank Account Information 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. Signature Date Filing a Claim When Shauld I File a Claim? If you have sustained an injury or damage for which you believe the City or one of its employees is responsible, you may file a claim against ihe City. How Do I Request a Claim �orm? In order to obtain a claim form, please contact or�isit one of the fallowing Ciiy offices: City Clerk's Office City Aitornev's Office City Hail Harbor View Place, Ste. 33D 50 W. 13th St. 3D� Main St. Dubuque, lA 52001 �ubuque, lA 52Da1 563_589.d120 563.583.4113 Can I 5end in Additional Infarmation with the Ciaim Form? Yes. It is recommended that you send in as much information as possible with your claim form in order to expedite the investigation vF the claim.This includas, but is not limited to, estimates, receipis, medical bills, pictures and any other information you feel may 6e�elevant to your claim. It is also recommended that you send in capies of these items and keep the originals for your records. What Happens After I File My Claim? Once a claim has been r�ceiv�d and file-stamped by the City Clerk, it is forwarded to the City Attorney's Office for investigati�n. Claims involving personal injury or substantial property damage will be forwarded ta the Ciiy's claims agency for investigation.Yau will receive a letter from the City Attorney's Office indicating that your claim has been forwarded to the claims agency. This letter will also contain the claims agency's contact information. A claims adjuster will then contact you regarding yaur claim. At that point, any qu�stions regarding your claim should be addressed to the claims adjuster. All other claims will be forwarded to the appropriate City department for investigation.After speaking with emplvyees and consulting department recards, the department manager/ supervisor will make a reGommendation as ta whether ihe claim should be approved or denied, Based on that information, the City Attorney will then make a recommendation to the City Council as to whether the claim should be approved or denied, If the City Attorney recommends ihat the claim be denied,you will receive a copy af th�department manager 1 supervisor's reporl along with the City Attorney's report to the Ciiy Cauncil. If the City Attomey recommends that the claim be approved, you will receive the City Attarney's report to the City Council as w�ll as a release form to be signed and returned to the Clty Attorney's Office.These are dnly recommendations. It is important to note that the final decision on all claims is made by the Cfty Council. No employee of the City has the authority ta make any representativn to you as io whether your claim will or will not 6e paid. If the City Council approves the claim for payment at its City Council meeting, a check will be mailed to you provided the Ciiy Attorney's Office has received yaur signed release farm. What if My Claim is �enied by the City Council? The City Gouncil makes its determination at City Council meetings,which are held ihe first and third Monday of each manth. We recommend writing a lett�r to the City Council indicating why yaur claim should not be denied and any addilianal information that you have ko support your claim. It is not necessary to appeal the City Attorney's recommendation for denial of your claim befvre the Gity Council makes its determination, however, you may do so.You are invited ta attend the City Council meeting when your claim will be decided; however, your attendance is not mandatory and you still have the right to appeal the City Council's decisian any time after it has been made. If your claim or appeal is denied,you have the option of filing a lawsuit in a court of appropriate jurisdiction. How Long ❑o I Have to Wait Before my Claim is Resvlved? The length of time it takes to investigate and resolve a claim depends largely on the nature of the claim and the amount of damages(nvolved. Some claims may take a few weeks ta resolve, while others may take longer. If you wish to check on the status of your claim or if you have any questions or cancems about the process, contact the City Attorney's Office at 553.583.4113. You may file a claim at any time. However, iF your claim is denfed by the City Council and you wish to file a Iawsuit, you shauld be aware that state law may limit the time in which to file a lawsuit. . . � . ' I '�+i � -` - .. , .� . �t?�;y � .Y.� �' ' .� � �. . . ' � � ,. � l � ,. �`�kP ��, ¢� � �r�'' . . ; � . ^ 3� ' ° 17�., { � ° . . . . � . � � ` �, 'I `� � � t � � - r s� . � y� �+�. y 'y " 'j ± '� . � � • , ' t _ �. . , �� , o ., _ :r z, t_� � a �,,� � � � � � -�%� i � . ��.:-. ��., ,, ��;� � � . . . . 5.� it, � � � ��. ' - � . <' �.. �* ' . ,. , . ' d � ' x�`z '+. �„' j � i. � � � .�. . ,t �. ,, a' . } � -.« '§ . � �f, .� - ;�a. " �'„ "�'e g -; . �v � ,� ��. . �. ._:., . < . . . , � � . . ''%�" _ �! - .�', E � �,�y* " � 7� .� C . . . • . X�F" (� �' . . 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'- 3 . ° d .� a ` �� � � '�I .: � a, ' . 1i � � � � • - - � � .�'e ,� , � r � � � ' k � ' � ',�' *y4 , • ; ` a �4 � '� ,� � . i�k � � +l�� , � h � . i�� r x �' �` «� R +�. � ar ♦ � �� t� - 1 � a9 � , � �3 �,..} � � . .�" , � ; ;� �` � � : i # 4 . ` . _ ��ir'� 1ii ,� $ � � �! � Wr,+� " ,� � � *E � :: ' � "�'� � � ` �, '� R ,�+ ' � 5 � ' � ,� ¢ �" rr. �y � �' � r4.� " � � S�iili � e �. � _. � � . e, �a t aY�� � � �d � : ��. � �'� � x� i#,i� " n �`� � �� � ,�� . K�+llk'_N � `���'.' �L � , ,�i s. '` p� . From: Jacob Schlosser To: Trish Gleason Subject: Claim for Jacob Schlosser Date: February 11,2021 7:22:30 PM Attachments: Claimform Citv.pdf Claim forJacob Schlosser Click here to report this email as spam. Copyrig hted March 1, 2021 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 forthe lowa Communities Assurance Pool:Asbury Square LLC for property damage;Ashlynn Johnson for property damage; Jackie Jones for property damage; Aaron Rang for vehicle damage; Jacob Schlosser for property damage; State Farm a/s/o Michael or Jennifer Connolly for property damage. SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description Type ICAP Referral Supporting Documentation THE CITY OF ��IBt_ E MEMORANDUM Master�iece on the Mississippi JENNYMESSERIC�� PARALEGAL To: Mayor Roy D. Buol and Members of the City Council Dare: February 16, 2021 RE: Claim Against the City of Dubuque by Jacob Schlosser Claimant Date of Claim Date of Loss Nature of Claim Jacob Schlosser 01/11/2021 01/20/2021 Property Damage This is a claim in which claimant alleges his vehicle was damaged when it fell through the City street as he was driving. This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager John Klostermann, Public Works Director Jacob Schlosser OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAM STREET DUBUQUE, IA 52001-6944 Te�ePrioNe (563)589�381 /Fa�c (563)583-1040/En�t4i� jemesser@cityofdubuque.org