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Claim by Angela Mangeno
City of Dubuque Copyrighted November 20, 2017 Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Angela Mangeno for vehicle damage for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and Attorney ATTACHMENTS: Description Mangeno Claim Vans Evers Claim Type Supporting Documentation Supporting Documentation and Frank Vans Evers File; Refer to City 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. 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: vo\910- n 9\o n (;) 2. Address: /' '4dallete-444 C,F .44 /9/ 4674.43 ,1,,„ (‘ Telephone Numbe- S6.3 74"! 4. Date of Incident: 5. Time of Incident: V, as CVC) 6. Location of Incident (Be specific): NJL r(VIAS NE ci-L (Cows+braA.ic.- •Co. at\A \i,VSEM'r, 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.) _a -was OfizKra cer- AS rAez4,1y- in 4hp Dr;tte (14 Cul" (MEN Dr% Penn .111/e.,. -.T(Abfrf *V‘e,,plirk(ed ark 14;" A no ar cffra......rn4,-fet.s4- —3 . What were weather conditions like? 16\9i Nr) 4Pell'f1 -‘011If) 9. Give name and address of any witnesses: N\r. KNASe-r h4.01 a N..s5 ale(' tosA h 0.0-4,arter eeTtore-• 10. Did police investigate'? (If so, give names of officers.) Car 4.1/4;(0-A1 Sx'\11-h 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). Al() - 7./an A/ 4i v•-t0„S kAsf 1(1+6 +he 61-rec-1- ufrt -1Arvc C (eal) rex-6M( irn - orcard,56 OrF)CER SrA,A.k e_dAte,- _i_o 4 -he scfg, She Utev) I was -4-hen --1-0\ci b ker-4A- vJcts (il-Cat.LI+.cknol Me 14usetz would -Coc- .Bcke..k(1 ufOrN, A- WiLigt-q f`GC.,1 tiK6 -Darkalc Prtm-F• 0C- rAl apt\ r)0 catm .Locl, j °tamae on rn9se.1-e- mai be_ sorvc e©p le woulot 5\kc, ()pet-A-LA.64 aAl ct&K s aleedg- ;or +he, clativ\CL3e 4-0 rve.,(\i`cdte_ --tizaAtieC MAC /111a-d-eal 117t4 ,,ux.acAdtitAcel eJrxti0a4ci t 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.) c-21ao k 1 (-). f(DOk CVQI " Q tkkik10 IM4H -0- 13. What other damages do you claim, if any? 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? 16. Why do you claim the City of Dubuque is responsible? t112., Kr -S012 tkhirtki.ivcq IAA n WhAearS IINSCtranae- k 1 5 e CO) 1 ittf - 140 C6 eArqOL& K04.41,e_ -1-tve se_ Pliakte.t% . 17. Have you -made any claim against anyon else for damages as a result of this incident? (If yes, give name and address.) 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? Dated at Dubuque, Iowa this3O day of 0,-714-1,64.) , 20 /7 (Rev. 7/12) (Signature) (Print Name) 4 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. I , Q10- Vc\ CA Mail , hereby certify that the attached documents include tLfollowing prMected 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. Date /7 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 weLl xtuflioc.11-- aa7t `-1 a4q 674(ft. Og, Jo,,7 Date lad•cd(4,2-- City of Dubuque ITEM TITLE: SUMMARY: SUGGESTED DISPOSITION: ATTACHMENTS: Description ICAP Referrals Copyrighted November 20, 2017 Consent Items # 3. Disposition of Claims 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: Angela Mangeno for vehicle damage and Frank Vans Evers for vehicle damage. Suggested Disposition: Receive and File; Concur Type Supporting Documentation Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL MEMORANDUM To: Mayor Roy D. Buol and Members of the City Council DATE: November 14, 2017 RE: Claim Against the City of Dubuque by Angela Mangeno Claimant Date of Claim Date of Loss Nature of Claim Angela Mangeno 11/13/17 08/14/17 Vehicle Damage This is a claim in which claimant alleges that a City Engineering employee backed a City vehicle into claimant's vehicle in the Dairy Queen parking lot on Pennsylvania Avenue. 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 Gus Psihoyos, City Engineer Angela Mangeno 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