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Claim by Jessica Martin 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 rY�v �n .�� , n`1 G r�-r LJ a�L S��k�� i s�� CLAIM AGAINST THE CITY OF DUBUQUE, IOWA This written report consti#u�es yaur cla�m against the City of Dubuque, towa. You should complete this form in full ar�d attach any addifional information that supports your claim. TF�e Cla�m must be filed with the Cifiy Clerk a# City Hal[, 5a W. 13`�' S#., Dubuque, IA 52001. It will then be referred by the City Clerk to the appropriate depa�tment far investigation. �nce that investigation is comple#ed, a report and recommendation will be submitted to the City Council, You will be prov�ded with a copy of tha# report anc� recommendation. +�'S /� ! ` f 1. Name of Claimant:�: �1. ' \ ��i�1� 2. Address: �� J� ��1 L�\� '�• r� �'� ��°� � � 3. Telephone Number: ��P � � � " �� ,,.., 4. Date of Incident: 5. Time of Incident: �` i C� ' 6. Location of Incident (Be specific): ��,. �t �r `� .,��1,�� ' ---�-f ��- ... 7. DESCRIBE ACCIDENT OR 4CCURRENCE THAT CAUSED IN�fURY OR DAMAGE. (Give full details upon which you base your claim, lfi a Ci#y employee was in�ol�ed, gir►e the e �loyee's name.} �� - c�-� � � � ��:��- ��e c;Fr��-c � l�r ` \ 'l . -`� �_ `Cr�l � � '� �,l 1��Cs�� 1''e � � , Z'�` � '�� -,�C�E` �� `�.�i � 8. What were weatl�er co�ditions iike? _____ ,_ ��;�`(1 ��-��4'1� 9. Give �ame and address of any witnesses.��'1 �' h�'�V�� :� ��?��'i� �( �_ 9 0. Did po ` e in�esti ate? lf so, gi�e names of o�Fficers.) �. � � �`� �� -'� �� 1,�� { �,� �{..)`,�.� .�-� ��. 1 ��, �__, ' 11, Was anyone injured? (If so, gi�e narnes, addresses, and extent af injuries). .�� '12. Was any damage done to property? (If sa, describe property and the extent of damages. Attach estimates of damages or describe basis for ascertaining extent of darnage,) .� � -�1 i � Y1 �' �7 �.�T� t�� 1 ��`�\� ��.r� `�r� . '13. What other darnages do you claim, if any? `� 14. Have you besn compensated for any pa�t or all of your claim by any insurance company? {If so, give name and address of insurance company and amount paid.� �� . �} �-; 15. What amount da you claim from the City of Dubuque?__�� ,: 16. Why do you claim the City af Dubuque is responsibfe? �� L.1u�� (-'� �. 1 -�\��`� �`�.'0 ��,'�. �� = �,�c"`J� �t C1 ��— r `1'1�� +.`Y ��-- �� '�`� ?-�- p�f . .� 17, Ha�e you rr�ade any claim against anyone else for dar�ages as a result of this incident? (If yes, gi�� name and address.) � � �; 'i8. I# the answer to Quest�o� 17 is yes, have you receiv�d any payment from #ha� source, and if so, in what amou�t? Dated at Duhuque, lowa this day of � �� , 20 � � , -- 1 �� {Signa#ure} _ ��, �� ;r.��.,�� _ ��::. {Pr�nt Name) � :k, � Confidential This comrnunication and any attachments may contain information w�ich is conf�dential and privileged by law and is �or the use of the designated recipiertt. lf you are nat the �ntended recipient, you are herel�y notified that you have recei�ed this communication in errar, and that any re�iew, disclasure, dissemination, dis#ribution or copying of �ts contents is prohibited. Please nofify City of Dubuque immediately by telephotte at (563)-589-4120 of your receipt of these items and des#roy the communication and any attachment� immediately. Further disclosure af this information may �iolate state and federal restrictions. Gonfidential informa#ion may ir�clude the following: 1)Social Security Number(s) 2}MeaicallHealth Information 3)PersonnellDisciplinary Information 4)Bank Accaunt I�rformat�on �)Financial Information 6}Credit Card Numbers If any cfocumenta�ion you desire to submit to the C�ty of Dubuque contains any of the items above this co��r sheet must be attached direcfly to the confidentiai information and indicate the type of information that is included. i, �� v � �.•'��' , hereby certify that the attached documents incluc�e the following protected in#ormation: �Sacial Security Number(s) �Bank Account Inforrrtafifon �MedicallHealth Information �Financ�aE I�formation �Personne[IC7isciplinary Information �Credit Card N�mber(s) I understand fihat this information rnay be dis#ributed within �he City organization or to agent's of the City for processing and I hereby authorize the City to act accordingly taking all precautians to protect my i�forr�ation frorn unnecessary distribution. ��i�� r � � �`�I�� Sig ature Date INvo1cE Joe Stuckey 2804 1/Z Jackson St. Phone: 563-258-3355 Dubuque, IA 52fl01 Emaii: )ess71006@Gmail.corn BTLL TO: �nvoice Date: b�27/2023 Jessica Marti� 3875 Oneida Ave. In�oice Number: 6272023 DUbuqu2� IA 524D1 Payrnent Due: 6/30/2Q�3 Description Amount Tree removal afF on the right back side o�th� home. $400.00 �---._.... � Subtotal $4Q0.4Q Tax Rate 7.00% Total Tax $28.00 / TOTAL $428.00 Thank you 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: 8/23/2023 RE: Claim Against the City of Dubuque by Jessica Martin Claimant Date of Claim Date of Incident Nature of Claim Jessica Martin 7/15/2023 6/25/2023 Property Damage This is a claim in which claimant alleges Claimant's home was damaged when a tree on City property fell onto it. 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 Steve Fehsal, Park Division Manager Jessica Martin 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