Claim by Courtney Schminkey 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
L-Aa, e
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA Cenci
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. 13th 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:
2. Address: U,:� riL&S L a
3. Telephone Number:
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4. Date of Incident:
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5. Time of Incident: �✓
6. Location of Incident (Be specific):
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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.)
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8. What were weather e(on'ditwns like?
9. Give name and address of any witnesses: IJ , \Lo\
10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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.)
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13. What other damages do you claim, if any? a
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?
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16. Why c o you claim the City of Dubuque is responsible? j
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17. Have you made any claim against anyone else for damages as a result of this incident?
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(If yes give name and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
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Dated at Dubuque, Iowa this iS-. day of ®, 20
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1�Y1- (Print Name)
(Rev. 7/12) r
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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.
N
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. j
hereby certify that the attached documents
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include he following rotected information:
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Social Security Number(s) Bank Account Information
Medical/Health Information Financial Information
Personnel/Disciplinary Information Credit Card Number(s)
understand that this information may be distributed within the City organization or to d 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.
ure 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
Signature Date
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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 CITY OF
UUBUQUE MEMORANDUM
Masterpiece on the Mississippi
TRACEY GTECK. LEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: May 19, 2017
RE: Claim Against the City of Dubuque by Kathryn Oleson
Claimant Date of Claire Date of Loss Nature of Claim
Kathryn Oleson 05/19/17 05/15/17 Personal Injury
This is a claim in which claimant alleges that she her knee was cut and her shoulder
wrenched when she fell of her seat while riding a City bus.
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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
Candace Eudaley, Transit Manager
Jodi Johnson, Transit Operation Supervisor
Kathryn Oleson
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
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 CITY OF
E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN d'
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: May 18, 2017
RE: Claim Against the City of Dubuque by Courtney Schminkey
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Claimant Date of Claim Date of Loss Nature of Claim
Courtney Schminkey 05/16/17 05/04/17 Vehicle Damage
This is a claim in which claimant alleges that her vehicle which was parked near the
intersection of W. 11t" and Race Streets was struck by a City of Dubuque refuse truck. 9
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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
Courtney Schminkey
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