Claim by Richard DagueCopyrighted
January 3, 2022
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Richard Dague for vehicle damage; Loeffelholz Trucking LLC for vehicle
damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Richard Dague Supporting Documentation
Claim by Lofferholz Trucking LLC Supporting Documentation
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. 13« 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: I-� 1
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2. Address: (�& L G-�1-�c r -RA
City:
State: --r{
3. Telephone Number: 7q a
4. Date of incident:
5. Time of Incident: M
Zip: 5c9-()C)
6. Location of Incident (Be specific): ke(,4ACG 1-E3f
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7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon whi h you base your claim. If a City employee was involved, give the
employee's name.)
8. What were weather conditions like?l�(
9. Give name and address of any witnesses:
10. Did police investigate? (if so, give names of officers.)
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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?
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. What amount do you claim from the City of Dubuque?
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16. WhV do you claim the City of Dubuque is responsible?� p tt� �11 _
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17. Have you made any claim against anyone else for damages as a result of this incident?
If Ves, give name and si
Adress.)
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 _ day of _� 20,
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(Rev. 5118)
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City of Dubuque
City Council Meeting
Consent Items # 3.
Copyrighted
January 3, 2022
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: Richard Dague for vehicle damage; Loeffelholz
Trucking L L C 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 Brad M. Cavanagh and
Members of the City Council
DATE: 12/29/2021
RE: Claim Against the City of Dubuque by Richard Dague
Claimant Date of Claim Date of Incident Nature of Claim
Richard Dague 12/21/2021 12/6/2021 Vehicle Damage
This is a claim in which claimant alleges claimant's vehicle was struck by a City bus.
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
Ryan Knuckey, Director of Transportation Services
Richard Dague
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