Claim by Kelsey Mentz/Julie Hoffman Copyrighted
September 18, 2023
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Jessicia Martin for property damage; Kelsey Mentz and Julie Hoffman for
vehicle damage
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Jessica Martin Supporting Documentation
Claim by Kelsey Mentz& Julie Hoffman Supporting Documentation
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CLAIM AGAfNST THE CITY OF DUBUQUE, IQWA
This writt�n repart constitutes your claim agains# the City of Dubuque, lowa. Yo� should
complete this form in full and attach any additional information that supports your claim.
The Claim musE be filed with the City Clerk at City Hall, 50 W. '13�" St., Dubuque, IA 52001.
It wifl then be referred by the City Clerk to �he appropriate department for investigatior�.
Once that investigation is completed, a report and recommendation will be submitted �o the
City Council. You wilt f�e pro�ided with a copy of that repart and recommendation.
Kels�y i lentz/.7�lie Haf�Fen�,n
1. Name of Claimant:
tq5� �V Grandview Hv� Dubuc�u�, Io�ua 5zp01
2. Address:
hb3-z13-8b$4�
3. Telepf�one Number:
SI3o/�Oz3
4. Date of Incident:
z;z0 �m
5. Time of Incident:
6. Lacation of Incident (Be specific): �!-� F'���,�ShuYy zau�
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT GAUSED INJl1RY OR �AMAGE. {Give
fu11 details upon which yo� base your claim. If a Ci#y employee was involved, give the
em�loyee's name.)
Sto���c�n SfrrJn �u_r..s rJriti�in�r. .iufn hus 1 w�s in tl�r� Ic�t f�n� i�rinr to t�� It��t turn fGn� kln� �is�s r�rovc ille�q�lly clnwn tl�o
turning Ic,ne (�Gr be�ore t�,e turn �or t4,� ligHf,the turn lane is for th� businesses) and the bac�C�uvnper cGught my�ront
GIYIVPY 5 S� Q LOYhFY
l=�ir
8. What were weat�er conditions like?
9. Give name and address of any witnesses:
10. Dicf police investigate? (If so, give names of officers.)
��^s-�:d�l _... .____u._..
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
IU0 DnC� WG5 �n)uYPC�
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.)
`/es,front end damage tn my car,back humper nn bus
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.)
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15. What amount do you claim from the City of Dubuque? 3112.67
16. Why do you claim the City of Dubuque is responsible? I
13ecause tl�e 7nliae rn�ort said the hus driver was res�annsible for ttie accident anel I was ubidin5 by tHe traffic laws
17. Have you made any claim against anyone else for damages as a result of this incident?
(�nyes, 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, lowa this day of , 20�
Kelsey Mentz
(Signature)
Kelsay Mentz
(Print Name) -.� ':�
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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 I
is prahibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of
your receipt of these items and destroy the cammunication 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 �i
6)Credit Card Numbers I
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. '
Ke1s¢y Mentz i
I, , hereby certify that the attached documents �
include the following protected information:
�Social Security Number(s) �Bank Account Information
� �MedicallHealth Information �Financial Information
�Personnel/Disciplinary Information �Credit Card Number(s) '
I understand that this information may be distributed within the City organization or to agenYs of '
the City for processing and I hereby authorize the City to act accordingly taking all precautions to
protect my information from unnecessary distribution.
Kelsey Mentz 5/11120z3
Signature Date
Copyrighted
September 18, 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: Jessica Martin for property damage; Kelsey Mentz and
J ulie Hoffman for vehicle damage
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description Type
ICAP Referrals Supporting Documentation
ICAP Referrals Supporting Documentation
THE CTTY OF
DUB E MEMORANDUM
MasterpTece on the Mississippi
� ONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Brad M. Cavanagh and
Members of the City Council
DATE: 9/14/2023
RE: Claim Against the City of Dubuque by Kelsey Mentz and Julie Hoffman
Claimant Date of Claim Date of Incident Nature of Claim
Kelsey Mentz 9/11/2023 8/30/2023 Vehicle Damage
and Julie
Hoffman
This is a claim in which claimant alleges Claimant's vehicle was damaged due to being
struck by a City bus.
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
Ryan Knuckey, Director of Transportation Services
Kelsey Mentz and Julie Hoffman
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