Claim by Derrick JohnsonCopyrighted
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
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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 �} f
complete this form in full and attach any additional inf�rltlation that cllpri]IJ1rts yn—ur claim_ �(i r�C✓
The Claim must be filed with the City Clerk at City Hall, 50 W. 13th 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:
2. Address: _3o!L wh`k S-f!✓.a
City: �kav� State: _ - 11V Zip: O e i.
3. i eiephone Number: 5�6 3" 9 s —3N3
4. Date of Incident: 1a_.` —zz
5. Time of Incident: - 0 Arl
6. Location of Incident (Be specific): D261vi
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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 vas involved, give the
employee's name.) {�rtv Cc � ."
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8. rVllut rr`rcic iiYCLIc11G1 conditions line?
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. Why do you claim the City of Dubuque is responsible?
17: Have you made any rlai�p anainct antenna eiSe for ria;r;anec as a rnei�if owfk a id- dent?
(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
day of 2�
Signature)
(Print Name)
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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 Derrick Johnson
Claimant Date of Claim Date of Incident Nature of Claim
Derrick Johnson 10/5/2022 10/4/2022 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
Derrick Johnson
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