Claim by Dennis ViertelCopyrighted
September 7, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Dennis Viertel for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Dennis Viertel Supporting Documentation
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,
include the following protected information:
Social Security Number(s)
Medical/Health Information
Personnel/Disciplinary Information
hereby certify that the attached documents
Bank Account Information
Financial Information
Credit Card Number(s)
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.
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Signature Date
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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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 CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: r)'£ k) N i S V IS (LTE L
2. Address: 2-P9 C>Ay�- 1wg-,Ao0yi C-(-
City:-0 Lk 9 u. wj, f-_ State: /A- Zip: sLe>03
3. Telephone Number: (56 5) Sif 3 - y 5 `d Z,
4. Date of Incident: A 13e, / zo-z i
5. Time of Incident: 1 � q 5 A , Alt
6. Location of Incident (Be specific): /Ay V £ H is t g Wq; TAAV LC ) JC Ncic-M
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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? d�R� 1 S(AwJ Y Vf jt
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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.)
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13. What other damages do you claim, if any? tio"C
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?
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16. Why do you claim the City of Dubuque is responsible?
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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 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
(Rev. 5/18)
3o day of U C-,u, s r' 20 2 1.
c�pl�ls' ViSc zL
Name)
Filing a Claim
When Should 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 the City.
How Do I Request a Claim Form?
In order to obtain a claim form, please contact or visit one of the following City offices:
City Clerk's Office
City Hall
50 W. 13th St.
Dubuque, IA 52001
563.589.4120
City Attorney's Office
Harbor View Place, Ste. 330
300 Main St.
Dubuque, [A 52001
563.583.4113
Can I Send in Additional Information with the Claim Form?
Yes. It is recommended that you send in as much Information as possible with your claim form In order to expedite
the investigation of the claim. This includes, but is not limited to, estimates, receipts, medical bills, pictures and any
other information you feel may be relevant to your claim. It is also recommended that you send in copies of these
Items and keep the originals for your records.
What Happens After I File My Claim?
Once a claim has been received and file -stamped by the City Clerk, it is forwarded to the City Attomey's Office for
investigation. Claims Involving personal injury or substantial property damage will be forwarded to the City's claims
agency for investigation. You 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 your claim. At that point, any questions 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 employees and consulting department records, the department manager f
supervisor will make a recommendation as to whether the 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 that the claim be denied, you will receive a
copy of the department manager 1 supervisor's report along with the City Attorney's report to the City Council.
If the City Attorney recommends that the claim be approved, you will receive the City Attorney's report to the City
Council as well as a release form to be signed and returned to the City Attorney's Office. These are only
recommendations. It is important to note that the final decision on all claims is made by the City Council.
No employee of the City has the authority to make any representation to you as to whether your claim will or will not
be paid. If the City Council approves the claim for payment at Its City Council meeting, a check will be mailed to you
provided the City Attorney's Office has received your signed release form.
What if My Claim Is Denied by the City Council?
The City Council makes its determination at City Council meetings, which are held the first and third Monday of
each month. We recommend writing a letter to the City Council Indicating why your claim should not be denied and
any additional information that you have to support your claim.
It is not necessary to appeal the City Attomey's recommendation for dental of your claim before the City Council
makes its determination, however, you may do so. You are Invited to 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 decision 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 Do I Have to Wait Before my Claim is Resolved?
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 Involved. Some claims may take a few weeks to resolve, while others may take longer. If you
wish to check on the status of your claim or If you have any questions or concerns about the process, contact the
City Attorney's Office at 563.583.4113,
How tong no I Have In File a Claim?
You may file a claim at any time. However, if your claim is denied by the City Council and you wish to file a lawsuit,
you should be aware that state law may limit the time In which to file a lawsuit.
City of Dubuque
City Council Meeting
Consent Items # 3.
Copyrighted
September 7, 2021
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: Dennis Viertel for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description
I CAP Referral
Type
Supporting Documentation
THE CITY OF
DUB E N N D H a
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Roy D. Buol and
Members of the City Council
DATE: 9/1 /2021
RE: Claim Against the City of Dubuque by Dennis Viertel
Claimant Date of Claim Date of Incident Nature of Claim
Dennis Viertel 8/30/2021 8/30/2021 Vehicle Damage
This is a claim in which claimant alleges claimant's vehicle was damaged due to a rock
projectile from a lawn mower being operated by a City Public Works employee.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
John Klostermann, Public Works Director
Dennis Viertel
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 589-4113 / FAX (563) 583-1040 / EMAIL jmedinge@cityofdubuque.org