Claim by Matthew Kline Copyrighted
August 7, 2023
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Matthew Kline for vehicle damage and personal injury; Donald Sloan for
property damage.
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Matthew Kline Supporting Documentation
Claim by Donald Sloan Supporting Documentation
�,�r� m
CLAIM A+GAINST THE C1TY OF DUBUQUE, IOWA ��"t
This written report constitutes your claim against the City of Dubuque, lowa. You should
compiete th�s 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. 13th St., D�abuque, IA 52001. It
wifl �hen !�e referred by the City Council to the appropriate department �or �nvestiiga#ian.
Once that investigation is compiefied, a report and recommendation will be submitted to the
City Council. You wifl be pro�ided 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 HA5 THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: State Farm Mutual Ins Co alslo Matthew Kline
2. Address: PO Box 106172 Atlanfia GA 30348-6172
3. Telephone Number: $77-787-8276
4. Date of Incident: 2�17123
5. Time o'F Incident: 07:59 AM
6. Location of lncident (Be specific): Drisco{I Rd & US 16� N & Sundown Rd
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. �Gi�e
full details upon which you base your claim. If a City employee was in�ol�ed, give the
employee's name.)
Cify of Dubuqu� vehicle, being driven by Randy Schuller, puEled aut ir� frant of insured vehicle, being driven
by Matthew Kline, who was unable to avoid collision.
8. What we�e weather conditions like? pry & Sunny
9. Gi�e name and address of any witnesses: nla
10. Did police investigate? (if so, give names of officers.)
Yes, PR �#2023005014
11. Was anyone injured? (If so, gi�e names, addresses, and extent of injuries).
lnsured sustained injuries including multiple fractures.
Insured Matthew Kline 220 W 2�d 5t A�t 200 Dubuque, IA 52�01.
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.)
Insured vehicle sustained damage to Engine,Front Bumper,Front Lamp(s)/Headlight(s),Roof i
13. What other damages do you claim, if any? n/a
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.)
Yes, State Farm Mutual Ins Co
I
15. What amount do you claim from the City of Dubuque? �
$32,513.49
16. Why do you claim the City of Dubuque is responsible?
City is reponsible for failure to yield.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
n/a
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
n/a
Murfreesboro, TN
Dated at Dubuque, lowa this 10th day of July 20 23
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/1P.CiG�/ �StaleFermMutuellnsCoelsloMatlhswKline 12:4Gi09-OS'00' (SIgPIatUPe�
Kelley Flenke State Farm Mutual Ins Co a/s/o Matthew Kline (Print Name)
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Copyrighted
August 7, 2023
City of Dubuque Consent Items # 03.
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: Matthew Kline for vehicle damage and personal injury;
Donald Sloan for property damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description Type
ICAP Referral Supporting Documentation
THE CTTY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
� ONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Brad M. Cavanagh and
Members of the City Council
DATE: 7/28/2023
RE: Claim Against the City of Dubuque by State Farm Mutual Insurance
Company a/s/o Matthew Kline
Claimant Date of Claim Date of Incident Nature of Claim
Matthew Kline 7/10/2023 2/17/2023 Vehicle Damage &
Personal Injury
This is a claim in which claimant alleges Claimant's sustained personal injuries and
vehicle damage due a City employee pulling out in front of his vehicle.
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
Barry Lindahl, Senior Counsel
State Farm Mutual Insurance Company a/s/o Matthew Kline
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944
TE�EPHONE (563)589-4113/Fax (563)583-1040/EMai� jmedinge@cityofdubuque.org