Claim by Richard Kaufman Copyrighted
June 5, 2017
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Cathleen Clausen for vehicle damage, Richard Kaufman for
vehicle damage, Mathew Kowalske for vehicle damage,
Kathryn Oleson for personal injury, Robert Mootz for vehicle
damage, Corrine Morris for vehicle damage, Carol Moyer
for property damage, Courtney Schminkey for vehicle
damage, suit by Kathleen McCarthy for the estate of
Thomas McCarthy for wrongful death.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City
Attorney
ATTACHMENTS:
Description Type
Clausen Claim Supporting Documentation
Kaufman Claim Supporting Documentation
Kowalske Claim Supporting Documentation
Mootz Claim Supporting Documentation
Morris Claim Supporting Documentation
Moyer Claim Supporting Documentation
Oleson Claim Supporting Documentation
Schminkey Claim Supporting Documentation
McCarthy Suit Supporting Documentation
IM
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 West 13t' St.,
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. 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: A]
2. Address: Ceag� 5�-rl-4-rloAl ��, 1 , a '�
3. Telephone Number �,3) - /-361) CC
4. Date of Incident:
5. Time of Incident:
k.
6. Location of Incident (Be specific):
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7. Describe the 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.)
2��g 14-71-4426��4>
8. What were weather conditions like? 0,06-01A)& 1444)
9. Give name and address of any witnesses: AL-DA I�WrMAM
&&L`MA -2rd-6104 RV.
10. Did police investigate? (If so, give names of officers.) IV6
11. Was anyone injured? (If so, give 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.)
13. What other you o damages dclaim if any?g Y � Y /VO4/F
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.)
NOi
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes, give name and address.) O
18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Dated this ;2,&—day of Y 2011. w
(Signature) _mx
11�A UrM A
(Print Name) '
I
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) Bank Account Information
5) Financial Information
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.
hereby certify that theattached documents
include the following protected information:
Social Security Number(s) Bank Account Information
Medical/Health Information Financial Information
Personnel/Disciplinary 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.
Signature Date
I have read the information above and do not have any confidential documentation to submit to the
City of Dubuque as part of this Claim Against the City
2-8 2-olkl
Signature' Date
Supplement to Claim Form due toSpace Limitations
#G USHwy 52-B1-151 —omit peoeee perpendicularly under the 3rd EkOverpass(that bridges traffic from
lower Main St in downtown DBO over to the Mississippi River Museum/port/harbor area.) �
i
#7 While traveling south on US Hwy 52-61-151, under the 3rd St Overpass, our vehicle was showered by a �
sheet of snow/slush. My wife(Aida Kaufman) noted that the plow truck maintaining the overpass above us was
flinging the snow over the side of the(northernmost)bridge barrier railing into our travel lane just as we went
under the overpass.
VVedonot know the name ofthe employee operating the plow vehicle,
#12 Our2O1SLexusRXOSO8UVauetainadonoppnox8"oneckondhverssidavv}ndoh|e|d.Theonuck
increased in length dioQnnm||y upward to passenger side as we waited semanal weeks for our windshield
replacement appointment. Photo is attached.The FU Rrmouftop sustained aanna||body ding.
Receipt and Estimate are attached--both are from Abra Body&Glass, DBQ, IA.
#15 Abna G}oao, Dubuque, |A —Receipt--Windshield Replacement— }nv#1017524 *736.09
Abra Auto Body, Dubuque. |A— Estimata-ropairpending— Paint|osaRprFt RrRoof Ding—$18O.0U
Total—$83&OQ
#16 Snowplow driver either carelessly or unwittingly caused accumulated snow/slush from his plow to
cascade over the bridge rail onto aU8Highway that wewere traveling. City of Dubuque owns and maintains
this structure. Our vehicle sustained damage from this incident and we incurred repair costs.
Richard Kaufman
6765 Massey Station Rd
Dubuque, IA 52003
Copyrighted
June 5, 2017
City of Dubuque Consent Items # 3.
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: Cathleen
Clausen for vehicle damage; Richard Kaufman for vehicle
damage; Mathew Kowalske for vehicle damage; Robert
Mootz for vehicle damage; Corrine Morris for vehicle
damage; Carol Moyer for property damage; Kathryn Oleson
for personal property; Courtney Schminkey for vehicle
damage; Kyle Stoffel for vehicle damage
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Staff Memo
THE TE CUY OF
U� MEMORANDUM
Mast€ iece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: May 31, 2017
RE: Claim Against the City of Dubuque by Richard Kaufman
Claimant Date of Claim Date of Loss Nature of Claim
I
Richard Kaufman 05/30/17 12/16/16 Vehicle Damage
This is a claim in which claimant alleges that as his wife was traveling on Hwy 52-61-
151 underneath the 3rd Street overpass, claimant's vehicle was showered with snow
and ice as a plow truck maintaining the overpass flung snow over the side of the
northernmost bridge barrier railing.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool
cc: Michael C. Van Milligen, City Manager
John Klostermann, Public Works Director
Richard Kaufman
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE,300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563)583-4113/FAx (563)583-1040/EMAIL tsteckle@cityofdubuque.org