Claim by Kyle FitzGerald Copyrighted
April 19, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Kyle Fitzgerald for vehicle damage; Jenny Rouse for property damage;
Drew Waller for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Kyle Fitzgerald Supporting Documentation
Claim by Jenny Rouse Supporting Documentation
Claim by Drew Waller Supporting Documentation
ConfidentEal
This communicatian and any attachmenfis may contain infiormation which is confiden#iai
arid priv��eged by law and �s #�r #1�e �se of #�e designa#er� recipien#. If you are not the
intended rec,ipient, you are hereby notified that you have received this communication in I
error, and tha#any r�vi�w, disctosure, d�ssernination, distribution or copying of its contents
is prohibited. Please notify Ci#y af Dubu���e immediate�y by tele�hone at (563}-589-4120 of '
your receipt of these items and destroy the corr�munication and any afitachments �
immediately. Furkher disctosure of this information may v�otate st�ate and federal �
restric�Eions�
Confidential inforrr�atian may include the fotEow'rng:
,
�) Soc'ra� Security Number(s}
2) Medic�llHealth infs�rmation
3) 1'ersc�nne11�3is�iplinary inf�rma�iar� i
4) Bank Accau�#1r�formation �
5) Financiallnformation '!
6) Credit Gard Numbers
t#any doc�r�aentati�n y�u desire to sub��t tca the �'it} t�f Dub�q�a� contains any of#he it�rr�s above �
this �over she�t must b� attacl�ed c�irec#i� #o �l�� caonfidentiai in�'ormation a�d indicatre the type o# I�
informatio�#hat is �n�cfuded. �I
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I, 1 , hereby eertify that the attached documents
inciud�the fol awing pcotected �nformation:
Social Security Number(s) Bank Acc�unt Informatior�
i
Medical/Health lnformation Financial Inform�t�on '
Person��lJfli��ip�i�ar� I�#orrraatit�r�� . . Cret�i�'Catd �iumber(s�
i u�derstar�d tha#this infarma#ior� r�ay be d�stribut�d e�ritt�ir� the Ci�r�rgan�zatic�n or t�agents of the
Gity far processing and 1 hereby authorize the Gity to act acccarding[y t�king a6l precautions fio
protect rny infarmation€rc►m unnecessary distribution.
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GLArm AGAINST THE CrTY QF DUBUQUE, IOWA , �-��������''� �
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This written r�port c�onstitutes your +claim against the Ci#y c�f Dubuque, lowa. You should
complete this form in#uil an� attach any addi#ionat inforrna�on th�t sup�or#s your claim.
The Clairr� must be filec!with the City Glerk at Ciiy Hai1, 5a W. "t3t�' St., pubuque, lA 520Q1. It i�
wili then be referred by fihe City Council to the apprapriate department for invest�gation. ,
Once that investigation is compteted, a report and recom�nendati4n witt be subm�tte�t �a tk�e
Ci�+y Co��c�1. Yau vv��i �ie prov�t�ed w�th� a�c��y�f#ha#�epor#�n�d recommendation. i
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T�� FINAL DEC�S1�J�i fJN ALL CLA1�VtS 1S�VIA�E 8Y T�tE C1TY�t)UN�IL. �1tC? EMP�OYEE QF
THE GlTY C3F dUBUQt.tE H�4S THE AtlTNORtTY Tt3 M�1,KE R�tY F�EPRESENTATta11t �`t3 YOU
AS TQ WHETHER YC�UR CLAIM WILL C)R W[LL Nf?T BE PAIQ - - - �. .._�„�: :�:"���� ��--�� �'
� �y1e�i�zger�ci '
1. �l�rrte of�la�mant: �- 124c�Univ�rsiry Ave
2. Addres�. r�� , Dubuque,T�1�2Q�1 �ry �
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City: state: �, zfp:�� V
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3. '�'"�:ie�fi�����m�rer. __ ��� ��'�., �� ��
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4. fl�te of lnc�+den#; ��� �,�� �� �-� ! I�
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5. 7'ime of lncident: �� �' �� �
+�. 1.�►cat�o�a fl�Inc�de�t(8e�p�eci#i+c); �� �� ���a�.� ..,��� �'�... � � �= t ��"`���'��
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7', flES�R1�E ACCt�E�1T fl!� ���CllR�E�CE THAT CA�SEA ��JURY OR �AMAGE. (G�ve �
full d�#ails upon which you base your �1aim. !f a City ernpioyee w�s �t�volved, give #he j
e�l��0yee'S name.) �
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8. V�Ma#were e�r�a#her c�nditic�ns I�ke? _°�";�� f��; ��.,�
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9. Give name�nd address of any witnesse�: , � ,�;,,���
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10. �i� p�ai�ce f�avestigate? {�f s4, give names a�offcerse)
�.��~.�`��,= F^�--i4i�,F"-. ,�.�'� ��'� �' ���€ '�!��'������.
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'19. UVa� any�n� ir�jured? (If so, give names, addresses, and extent of injuries),
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12. Was any damage done to property? (!f so, describe praperfiy and the extent of
damages. Attach estimates of damages or describe basis for ascertaining extent of
damage.)
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13. iN�at ot�er dama �'S tl+� �l1 ��+r'�it�li if an � f `� �
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14. Have you been compensa�ed f�ar any part or atl of your cfaim by any insurance �
campany? (1#ss�, g��r�e r�ac�e a�s�a�ddress o#�nsuranc�cc�m{�a�ay�nd arn�unt paid.)
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'(5. What amount do yuu claim frarri the City of Dubuque? � � �: ,� � �;
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16. 1i�it�y��y�u c�a��#�Q�C�#�r�#����qu��s �s�a��asib�e? �I
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17d Have you made any claim a�ainst an�ene else�or dam�c�es �s�21 �'GSUI'�O$'��'t#S tMCfCC��flt? I�
(�f yes, give nam�and address.) �
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18. 1f t�e an�wer t+a t�uest��n 1�' is �es, f�a�re �ou rece��red any payment firom that saurce,
and if so, in wvha#amount?
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Dated at Dubuque, lowa this � day of �����. , 20���.
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Driver Information Exchange Report
DUBUQUE POLICE DEPARTMENT
(563) 589-4410
Driver's
U
N
Name - Last
DEWELL
Address
First
CATHERINE
Middle
ANN
Su ffix
Age
�6i
render
I
T
198 ALPINE ST
-
City
DUBUQUE
State
IA
Zip
52001-0000
!FEMALE
HomelCell
(602) 819-8186
Phone Number
001
CDL? Driver's License Number
YES
lass Ctate
B
�,SInsurance
f IA
!Endorsements
LP
Restrictions
BEKM
Insurance Co Name Co. Phone #
IOWA COMMUNITIES ASSURANCE
Owner Company Name
CITY OF DUBUQUE
Owner's
(515) 278-9400
Insurance Policy #
CERTIFICATE NO: 53
Name - Last
Address
First
Middle
Suffix
50 W 13TH ST
City DUBUQUE
DUBUQUE
State
Zip
52001
Vehicle Configuration
24
VIN No.
15GGE221521090494
Year
2002
Make
GILL
Model
TRANSIT BUS LOW
BUS
Color
GRN
License Plate #
State
NO
Year
Mast
02 -
Damaged Area
FRONT PASSENGER SIDE
Approximate Cost
$2,000.00
to Repair or Replace
Driver's Name - Last
First
Middle
Suffix
Age
Gender
N
j
T
Address
COL?
City
State
Zip
—_
Home/Ceil'Phone
(563) 542-686
_ _ ...--
Number
002
!Driver's License Number
.
#Cie !State
Endorsements
Restrictions
insurance Co Name Insurance Co. Phone #
Owner Company Name
Owner's
Insurance Policy #
Name - Last
FITZGERALD
Address
First
{KYLE
- IGEOFFREY
Middle
Suffix
1240 UNIVERSITY AVE
VIN
'State
DUBUQUE
5IA 520010000
2
Vehicle ConftguraGon
02
No.
1FT8W3BT3HE017912
ear
2017
Make
FORD - FORD
1F35
Model
PtKe
PK
Color
BLK
License Plate
REUSE
State
IA
Year
2021 �09
Most
- MIDDLE
Damaged Area !Approximate
DRIVER SIDE Cost
$50.00
to Repair or Replace
County
DUBUQUE - 31
Accident occurred within corporate
DUBUQUE - 2100
limits of (city)
Literal Description
BLUFF ST MEASURING 239 FEET SOUTH FROM BLUFF ST
X
AND W 11TH ST
Coordinate
00691436
Y-Coordinate
�04708162
If accident occurred outside of city 1 Direction
limits show general vacinity: of
Nearest City
�Roufe Direction
Travel Direction
On Road, Street, or Highway:
At Intersection with:
Distance
Definable
!Direction
and 'Distance
'Distance
Direction
of
Milepost Number
Or
intersection, bridge or railroad crossing
Officer
OFFICER DYLAN DOERGES 1/3adge
No_
86
aw Enforcement
2020-007468
ese Number
J11/10/2020
Date of Accident Time of Accident
16:39 Hrs.
Quote: 10221 �
• Phone (563)875-2409 Account• PR
FAX(563} 875-7482 Salesman: 000466
Tt�IIFf�ee '!-$$8-$75-2409 Date; 04/07/2021
3�3584 41d�Hawkeys Rd.
Dyersville, towa 52040 www.victoryfordon�ine.Com
Customer: 32059
FITZGERALD, KYLE GEOFFREY �
1240 UNIVERSITX AVE �
DUBUQUE IA 52{?01
Piion�: 5f3-542-�i8671553-542-6867 ',
Qt�,r part Number/Desc�ip�i.on I�ocati�n On Hand List Price Sa3.c� Price Total �
1 HC3Z176$3KA SaP fl 1588,45 1688.45 1688.45
MIRROR ASY - REAR VTEW '
1 �P�*��pR 75.00 75.00 75.00 `
CHARGE 'i
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Any w�rranties dn the prod�.�cts solci h�reby are th�se made by
Lhe manufacturar. The selier hereby sxpressly disclaims all
rrarranties, aitner expressed or i.mplied, inclaading any
rrarranty of inerchantabil_ty or fitness for a particul.ar
pur�Qse, and neither assazmes n�r authorizes any oth�r p�rsc�n
to assume for it any liabii_ty in connection ;�ith the saici
sale of said prociucts.
• ALL RET°:3RNS MUS'P BE MADE WITHIN 10 DA'IS AND SUBJECT Tt� 20 0
HANC3LING CHARGE.
• Id0 REFUtdDS ON EL�CTRICAI, PAIZTS OR SPECIAi ORDER PAR'S�.
• 1�LL RE3'URNED PARTS MUST BB IN L)RIGINAL SA?.EABL� PACKAGING.
Tatal Parts: 1763.45
Tax: 123.44
Signature. Quote Total: 1886.89
Printed: 04/07/2021 03:22:58 PM This a.s a quote. Quoted prices subject ta change, Page 1 of 1
Copyrighted
April 19, 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 for the lowa Communities
Assurance Pool: Kyle Fitzgerald for vehicle damage; Jenny Rouse for
property damage; Drew Waller for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description Type
ICAP Referral Supporting Documentation
THE CSTY OF
DuB E � � � o p � H a � �
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Roy D. Buol and
Members of the City Council
DATE: 4/14/2021
RE: Claim Against the City of Dubuque by Kyle Fitzgerald
Claimant Date of Claim Date of Incident Nature of Claim
Kyle Fitzgerald 3/1/2021 11/10/2020 Vehicle Damage
This is a claim in which claimant alleges claimant' vehicle was struck by a City bus.
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
Russ Stecklein, Interim Director of Dubuque Transportation Services
Kyle Fitzgerald
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TE�EPHONE (563)589-4113/Fax (563)583-1040/EMai� jmedinge@cityofdubuque.org