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Claim by Deann BergfeldCopyrighted April 1, 2024 City of Dubuque Consent Items # 02. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUMMARY: Deann Bergfeld for vehicle damage. SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney DISPOSITION: ATTACHMENTS: Description Type Claim by Deann Bergfeld Supporting Documentation mVm CLAIM AGAINST THE CITY OF DUBUQUE, IOWA This written report constitutes your claim against the City of Dubuque, Iowa. You should complete this 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. 13t" St., Dubuque, IA 52001. It will then be referred by the City Council to the appropriate department for investigation. Once that investigation is completed, a report and recommendation will be submitted to the City Council. You will be provided 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 HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. 1. Name of Claimant: Pe-anll 2. Address: `I City: 1�zrr,,ar� v State: --Tc)wq 3. Telephone Number: ._-j 170 %'00 4. Date of Incident: 5. Time of Incident: 2 u / Ja-iuta /--L4 Jca, Zip: Q �6�� � We rvi� wQ� 4Y�-, 4;r -�yc' s� / I et 6. Location of Incident (Be specific): �U- CCLS+- s- 9 page L 1 q 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. If a City employee was involved, give the employee's name.) � e-aG a,P Ka-r,10A-e (4 -r-t� n2L_r �cii t,�,,�� �hc�t��l � �i-t�1 wtTl td arq- Vba-, h Off. 8. What were weather conditions like? tt r roayl--f 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) l 1 — � Is of cLs N-4 CL Nl i hL i CI�C �L I ��L'��� �� r ,2- �, C L r f S i 1')V`-S4l 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). Nl& 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.) 13. What other damages do you claim, if any? NC'rol t' 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? � /6 - 0 16. Why do you claim the City of Dubuque is responsible? yes 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) ,, ii 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? �,A r Dated at Dubuque, Iowa this �day of �1"� It Erg �� 20 Signature) Print Name) (Rev. 5/18) ry _07 s 5 FTYj 1Lt lr'rT�+ c � �s M f1 0 CD City of Dubuque City Council Meeting Consent Items # 03. Copyrighted April 1, 2024 ITEM TITLE: Disposition of Claims SUMMARY: City Attorney advising that the following claims have been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool: Deann Bergfeld for vehicle damage; Azariah Martin for vehicle damage; Kirtland Thayer for vehicle damage. SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description I CAP Referral Type Supporting Documentation THE CITY OF DUB E MEMORANDUM Masterpiece on the Mississippi JONI MEDINGER LEGAL ADMINISTRATIVE ASSISTANT To: Mayor Brad M. Cavanagh and Members of the City Council DATE: 3/26/2024 RE: Claim Against the City of Dubuque by Deann Bergfeld Claimant Date of Claim Date of Incident Nature of Claim Deann Bergfeld 3/18/2024 Dec. 2023/Jan. 2024 Vehicle Damage This is a claim in which claimant alleges Claimant's vehicle has been damaged due to salt and water dripping from the ceiling above a parking spot in a City parking ramp where Claimant's vehicle parks. This claim has been referred to the Iowa Communities Assurance Pool. CC' Michael C. Van Milligen, City Manager Ryan Knuckey, Director of Transportation Services Deann Bergfeld OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 589-4113 / FAX (563) 583-1040 / EMAIL jmedinge@cityofdubuque.org