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Claim by J P Gasway Co Inc Copyrighted October 16, 2023 City of Dubuque Consent Items # 02. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: Jill Boge for vehicle damage; Mary Burke for vehicle damage; Linda I rish for vehicle damage; J P Gasway Co I nc for vehicle damage; Lori Meyer for property damage; Mercy One Medical Center for property damage; Erica Nelson for vehicle damage SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Claim by Jill Boge Supporting Documentation Claim by Mary Burke Supporting Documentation Claim by Linda Irish Supporting Documentation Clim by Mercy One Medical Center Supporting Documentation Claim by Lori Meyer Supporting Documentation Claim by Erica Nelson Supporting Documentation Claim by J P Gasway Co Inc Supporting Documentation ��vm �� t�1�t�i� 1�a r-� CLAIM AGAINST THE CITY OF DUBUQUE, �4WA ��-�.v�.Fz-ha�.l This written repart constitu#es your claim aga�nst th� City of Dubuque, lowa. You sho�ld complete this form in full and attach any additionaf information that suppo�ts your claim. The Claim must b� filed with the City Clerk at City Hal1, 50 W. 13{'' St., Dubuque, IA 520D'I. It wil! then be referred by the City Council to t�e appropriate departmen� for inves�iga#ion. Once that in�estiga�ian is completed, a report and recornmendation will be submitted to the City Council. You wili be pra�ided with a copy of that report and recomrn�ndation. THE FfNAL DECISION QN A�.l. CLAIMS iS MADE BY THE CITY COiJNClL, NO EMPLOYEE OF THE CITY O� DUBUQUE HAS THE AUTHARfTY TO MAKE A{VY REPRESENTAI'ION T� YOU AS TO WHETHER YOUR CLAIM WIL.I. �R WIl.L NOT BE PAID. 1. Name of Clairnant: UNITED FIR� GROUP A.S.O J P GASWAY CO INC 2. AddreSs: �O BOX 73909 City: CEDAR RAPiDS State: �A Zrp; 52407 3. Telephone Number: $aQ-�13-939� 4. Date of �ncident: 4/28/2023 5� Time of Incident: 6. Location of Incident (Be specific}: CHANEY RD HEADED TQ DUBUQUE COMMUNiTY SCHOOL. 7. DESCRIBE ACCIDENT OR QCCURRENCE THAT CAUSED INJURY OR �AMAGE. {Give full detaiis upon which you base your claim. If a City �mployee was invol�ed, gi�e the employee's name.) INSURED DRIVING DOWN AUSBURY ABOUT 1Qp0 FEET BEFORE TURNfNG ONTO CHANEY RD, TREE BRANCH EXTENDING WTO ROAD WAY STRUCK TOP O� INSURED TRUCK. T 8. What were weath�r conditions like? WINDY 9. Give r�ame and address of ar�y witnesses: 1fl. Did police investiga#e�? {If so, giVe names of officers.) 1'I. Was anyane injured? (If so, gi�e narv�es, addresses, and extent of injur�es). N0. ONLY PROPERTY DAMAGES TO VEHiCLE 12. Was any damage done 1:o property? (If so, describe property and the extent of damages. Afitach estimates of damages or describe basis for ascertaining extent of damage.) � I TREE LINE3 DAMAGES TOP OF INSURED BOX TRUCK. PLEASE SEE ATTACHED PICS. � 13. What other damages do you claim, if any? � RENTAL FEES AND TRUCK REPAIRS 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.) $9,415.74 PAID BY UNITED FIRE GROUP INCLUDING INSURED 500.00 DEDUCTIBLE PAYMENT II I 15. What amount do you claim from the City of Dubuque? $9,415.74 16. Why do you claim the City of Dubuque is responsible? CITY OF DUBUQUE HAD DUTY TO MAINI'AIN TREE BRANCHES DUTIES BREACHED: MAINTAIN OVERGROWTH TREE BRANC 17. Have you made any claim against anyane else fmr daonag�s as a result of this incide�nt? (If yes, give name and address.) CLAIM FILED WITH iNSURANCE TO RCPAIR AND REIMBURSG BACK PARTIAL RENTAL FEES 18. If the an§wer fia Gluestion 17 is yes, have you received any payment firom that source, j and if so, in what amount? I�ated at OPTUlIA , L.OUISVULLE KY this 251"H �ay o¢ September zp 2g , ( , I ��--�� (Signature) Jack LeFeber �_ (Print Name) � > 7- ,� ;t-, ' 'ti I _ - i_i'? i,, �-` :;� ?�l (Rev. 5118) ,- cr �-� _ „. 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 recipfent, you are hereby notified that you have received this cammunication in error, and that any review, disclosure, dissemination, distribution or copying af its contents is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of your receipt of these items and destroy the communication and any attachments immediately. Further disclosure of this information may violate state and federal restrictions. Confidential information may include the following: 1) 5ocial Security Number(s) 2) Medical/Health Information 3) Personnel/Disciplinary Information 4) Bank Account Information 5) Financial Information 6) Credit Card Numbers If any documentation you desire tn submit to the City of Dubuque contains any of the items above tliis cover sheet must be attached directly to the confidential information and indicate the type of information that is included. I, ��-Q^��- , hereby certify that the attached documents � inciude e follawing protected information: � ___Social Security Number(s) Bank Account Information I, Medical/Health Information X Financial Information ' Personnel/C7isciplinary Information Credit Card Number(s) I understand that this informatian may be distributed within the City organization or to agents of the City for processing and t hereby authorize the City to act accordingly taking all precautioris to protect my inforrriation from urinecessary distribution. �� .�_.o..�ec4a�. 9/25/2023 Sig ture �ate � Copyrighted October 16, 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: J ill Boge for vehicle damage; Mary Burke for vehicle damage; Linda I rish for vehicle damage; Lori Meyer for property damage; Erica Nelson for vehicle damage; J P Gasway Co I nc for vehicle damage SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description Type PERS Jill Boge Supporting Documentation PERS Mary Burke Supporting Documentation PERS Linda Irish Supporting Documentation PERS Lori Meyer Supporting Documentation PERS Erica Nelson Supporting Documentation PERS- P J Gasway 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: 10/5/2023 RE: Claim Against the City of Dubuque by United Fire Group a.s.o J P Gasway Co Inc Claimant Date of Claim Date of Incident Nature of Claim United Fire Group 9/25/2023 4/28/2023 Vehicle Damage a.s.o J P Gasway Co Inc This is a claim in which claimant alleges Claimant's vehicle was damaged after Claimant drove under a tree branch extending into the roadway and struck the tree branch. 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 United Fire Group a.s.o J P Gasway Co Inc 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