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Claim by Erica Nelson 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 ��r'�'i�+�l �� -r CLAIM AGAINST THE CITY OF DUBUQUE, IOWA � }��N This writt�rt report constifutes your claim against the City of Dubuque, [owa. You should complete this form in fiull and attach any additional informat�on that supports your claim. The Cfaim must be filed with the City Clerk at Ci�y Hall, 50 W. 13t�' St., ❑ubuque, IA 52001. It will then be referred by the City Ca�ncil to the appropriate department for in�esfiigatian. Once �hat investigation is cornpleted, a report and recommendation will be submitted to the City CouRcil. You will be pro�ided with a copy of that repart and recommendation. THE FINAL DECIS�ON ON ALL CLAIMS IS MADE BY THE CiTY CQUNCIL. NO EMPLOYEE O� THE CITY OF DUBUQUE HAS THE AUTHORfTY TO MAKE ANY REPRESENTATION 70 YOU AS TO WHETHER YQUR CLACM WILL OR WILL NOT BE PAI�. 1. Name of C[aiman�: R��i ! ,�1 � ��- L� C� � 2. Addr�ss: ��` (� ., � 1�"t� ��. �� .. City: [ - State: � C.� � «. Zip: � �''�� 1 � f 3. 7e�ephone Number: � �' �-' �— � (C�� 4. Da�e of Ir�cident: � �� --�c�� 5. Time of Incident: 1 �` � c�' fi. Location of Incident (Be specific}: J ' I ��' .J�= " ('.r ��'�� ,��;� �� -- �1 n �� 1 1�� -' /'r�c��'�� ;�4 �� 7 " C) �-��Ca �'r a�;�.� 7. DESCRiBE ACCIDENT OR OCCURRENCE THAT CAUSED INJtJRY OR DAMAGE. (Give full details upon which you base your claim. If a City emplayee was involved, gi�e the employee's nam�.) �� r� � E^.� t f��Jc?t� � �'f�;� c� t-1 �,� T!' Cz c' � � � (��'� ��l'�-�� 1 �^.0 t� )�r�� f, 8. What wer� weather conditio�s [ike? `'�G2��r; C�� ; U2 9. Give name and address of any witnesses: .�� 10. Did police investigate? {If so, give names of officers.) C� �� L �'.�'� ` �+ � /i,/L C'-�� l�c;. ./��: � �� 11. Was anyone Enjured? {If so, gi�e names, addresses, and extent of injuries). �� , ; 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.) _ � - .-e�, � �U� T � Q, � � � c')11� AI i 13. What other damages do you claim, if any? !`� I 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? n U� � �J , - 16. Why do you cla� the City�ubuqu�is respo�sib�e? ( v�� , � �,,�.�� ►n.,�r , .�, I 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) p, \ � � v 18. If the answer to Question 17 is yes, have you received any payment from that source, � and if so, in what amaunt? � � ,(� }'"� Dated at Dubuque, lowa this D� day of ��'�'� , 20� ��^�``' '"----- (Signature) i . i �� 0 4�-.�'~"� �'`�-� �1� � (Print Name) r. - Ui � � . _ � -� � :T �—, _a � rr; ' s= �a - r,;,; _-- � (Rev. 5/18) `' �r7 1 � I ;_�_�~ �� III 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 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) Social Security Number(s) 2) Medical/Health Information 3) Personnel/Disciplinary Information 4) BankAccountlnformation 5) Financiallnformation 6) Credit Card Numbers 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. . � . t� 1 I, � �� C� , �J��t�� , hereby certify that the attached documents inciude the following protected information: Social Security Number(s) Bank Account Information Medical/Health Information Financial Information PersonneUDisciplinary Information Credit Card Number(s) I understand that this information may be distributed within the City organization or to agents of the City for processing and I hereby authorize the City to act accordingly taking all precautions to protect my information from unnecessary distribution. '� (.-!.!./C!+°-'��I,�''�---_ ��J fl °�_��-j '� Signature Date i I I. � I II I�I 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 Masterpiece on the Mississippi � ONI MEDINGER LEGAL ADMINISTRATIVE ASSISTANT To: Mayor Brad M. Cavanagh and Members of the City Council DATE: 10/4/2023 RE: Claim Against the City of Dubuque by Erica Nelson Claimant Date of Claim Date of Incident Nature of Claim Erica Nelson 10/3/2023 9/28/2023 Vehicle Damage This is a claim in which claimant alleges Claimant's vehicle was damaged due to being struck by a City fire truck. 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 Amy Scheller, Fire Chief Erica Nelson 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