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Claim by Aaron Rang 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 Confidential This communication and any attachments may contain information which i.s c.onfidential 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. ' I Confidential information may include the following: � i 1) Social Security Number(s) � 2) Medical/Health Information 3) Personnel/Disciplinary Information � 4) Bank Account Information i 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 �i this cover sheet must be attached directly to the confidential information and indicate the type of �� information that is included. � I; 4 � H �, �. .� �� ' , hereby certify that the attached documents � include the followin g protec d information: Social Securit Number s B � Y ( ) ank Account Information � Medical/Health Information Financial Information i� PersonneUDisciplinary Information Credit Card Number(s) I understand that this ir�formation 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. �� ' . � ,.�°�� .� 'Sig a u e Date � � ^ �67 B��v� �,�'8 C�� ra'ea �c�.�� . ,`� �' r ��. � � �/� � ��'� /�L c�- ,,�'.x��-`�e�i7� ,�,� �� p ��-�— r��, .�� ,c,�. ��`''�'�. �i�.7�.r°� �" �i�--C_.,"'- r�✓� /��r.�r��ti� � � �� I � CLAIM AGAINST THE CITY OF D °� �'�QS�`�'��'�' UBUQUE, IOWA � ��,��. �'�is written report constitutes your claim against the City of Dubuque, lowa. You should c�mplete this form in full and attach any additional information that supports your claim. "��e Claim must be filed with the City Clerk at City Hall, 50 W. 13t" St., Dubuque, IA 52001. It v�i�l then be referred by the City Council to the appropriate department for investigation. Ql�ce that investigation is completed, a report and recommendation will be submitted to the C'ity Council. You will be provided with a copy of that report and recommendation. ?I�E FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF T�E CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU �1S TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. �� Name of Claimant: 2, Address: � ��4� /Vo�� .�1�'.�l i��.1A ��o'V� City: ,�u.��c,R�-'ei State: �cy t,Jc�. Zip: �/ 3. Telephone Number. �5�3J SS'4 '��0 4. Date of Incident: � `�� ,� 5• Time of Incident: � �� /�') 6, Location of Incident (Be specific): ��'e��,�fiar� p-� �sor, ��,��'�� 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give fu�l details upon which you base your claim. If a City employee was involved, give the employee's name.) - !' /,d-�/ � �I.,) �y��,�� A.T �S/G� S�1f�A1 u�rL ,�N�l��l"1�� i1 �/�O�w�P� " �� ' � �/,� na d-�t�. �,�t1°, r.o�ln�,v� o�,r� o�GG, V1 , �' ve.. G STo,� S�i5�/`� P/ g. What were weather conditions like? ��1 �j/�, GcV g. Give name and address of any witnesses: `i 10. Did police investigate? (If so, give names of officers.) � ['� n'G�2r" E J....� 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). _� �('J ; 12. Was any damage done to property? (If so, describe property and the extent of darnages. Attach estimates of damages or describe basis for ascertaining extent of damage.) m� ��r �nl�s G�-v�s�i�e�( w 13. What other damages do you claim, if any? �/�,�p 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.) 15. W�at amount do ou claim from the i y of Du uque? ; �' �e,� � , ,� ' ------ � �� ,e, � ; 16. Why do you claim the Ci#y of Dubuque is responsible? � ��'f�� 'j � ' n, � i' � �,� r n il a t�'� i `t�ran�'� i� 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 an �� swer to Question 17 is yes, have you received an � ' and if so, in what amount? Y payment from that source ;I ,� i� i Dated at Dubuque, lowa this �'��'day of � a, � _, 20�. (Signature) � ��"�' .. � (Print Name) :m�� ,; � ;:�- �'�� s� ��, � � � � s� �� F�"7 � r�� f: � � (Rev. 5/18) � ,,�, �� 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 CTTY OF DUB E MEMORANDUM MasterpTece on the Mississippi �ONI MEDINGER Legal Administrative Assistant To: Mayor Roy D. Buol and Members of the City Council DATE: February 23, 2021 RE: Claim Against the City of Dubuque by Aaron Rang Claimant Date of Claim Date of Loss Nature of Claim Aaron Rang 02/17/2021 02/16/2021 Vehicle Damage This is a claim in which claimant alleges their vehicle was damaged by a City snow plow. 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 Aaron Jones OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)589-4113/Fax (563)583-1040/EMai� jmedinge@cityofdubuque.org