Claim by Michael BlaserCopyrighted
October 17, 2022
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Black Hills Energy for property damage; Michael Blaser for vehicle
damage; Derrick Johnson for vehicle damage; Lucas Spencer for
vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Black Hills Energy Supporting Documentation
Claim by Michael Blaser Supporting Documentation
Claim by Derrick Johnson Supporting Documentation
Claim by Lucas Spencer 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. 131h 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: A C14 ASEL &A-Y 1L_
2. Address: J 8113 SlEuc& n l�A R 1 Y) G C
City: GELLrVL4E State: Izip: S;u31
3. Telephone Number: 5` 03 - dL13-
4. Date of Incident: " 1 1 14 j 21
5. Time of Incident: 1146 AA
6. Location of Incident (Be specific): a ld4 a DO— 3R5 F . I' p,2T"1-k of
Ave NukgLwui�j
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? C1-c Ia 2
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).
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? t\ pbt��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.)
15. What amount do you claim from the City of Dubuque? i gy
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, t
and if so, in what amount?
you received any payment from that source,
Dated at Dubuque, Iowa this 0A b day of S937LMR ems=- 20
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City of Dubuque
City Council Meeting
Consent Items # 03.
Copyrighted
October 17, 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: Beidler Towing for vehicle damage; Black Hills Energy
for property damage; Michael Blaser for vehicle damage; Juanita Gates
for vehicle damage; Debra Heim for property damage; Derrick Johnson
for vehicle damage; Lucas Spencer for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description
I CAP Referral
Type
Supporting Documentation
THE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Brad M. Cavanagh and
Members of the City Council
DATE: 10/5/2022
RE: Claim Against the City of Dubuque by Michael Blaser
Claimant Date of Claim Date of Incident Nature of Claim
Michael Blaser 9/28/2022 9/16/2022 Vehicle Damage
This is a claim in which claimant alleges Claimant's vehicle was struck by a City
garbage truck.
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
Michael Blaser
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