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Claim by Ramona Fraction Copyrighted December4, 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 lowa, the agent for the lowa Communities Assurance Pool: Donovan Properties, LLC for property damage; and Ramona Fraction for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referral Supporting Documentation TFiE CTTY OF � �� V� � � L � 0 1\ A 1 \ � V � Masterpiece on the Mississfppi TRACEY STECKLEIN JL.t�' PARALEGAL ��, �l To: Mayor Roy D. Buol and Members of the City Council DATE: November 17, 2017 RE: Claim Against the City of Dubuque by Ramona Fraction Claimant Date of Claim Date of Loss Nature of Claim i Ramona Fraction 11/17/17 09/28/17 Vehicle Damage � , This is a claim in which claimant alleges that a tree branch fell onto and damaged her h vehicle while the vehicle was parked in front of 2112 Jackson Street. This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance PooL I i cc: Michael C. Van Milligen, City Manager Steve Fehsal, Park Division Manager - Tom Kramer, Urban Forester Ramona Fraction OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/Fax (563)583-1040/Ennai� tsteckle@cityofdubuque.org � � 9 � � 0 THE CTTY OF L�UB � E MEMORANDUM Master�aiece on the Mississippi TRACEY STECKLEIN ,�� PARALEGAL � � I To: IVlayor Roy D. Buol and � Members of the City Council � � �i DATE: November 29, 2017 i; 4 f RE: Claim Against the City of Dubuque by Donovan Properties LLC ,i � ;� Claimant Date of Claim Date of Loss Nature of Claim ', �I� Donovan Properties 11/28/17 During Access Property Damage LLC Ramp Project I Installation �i �; This is a claim in which claimant alleges that the outdoor post and stairway attached to " the building at 830 Rhomberg was damaged at the time of the access ramp project � installation at the corner of Humboldt Street and Rhomberg Avenue. ,� This clairtl has been referred to Public Entity l�isk Services of lowa, the agent for the lowa � Communities Assurance Pool. � cc: Michael C. Van Milligen, City Manager � Gus Psihoyos, City Engineer ' Rob Donovan, Member, Donovan Properties LLC i � Q OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA � SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/F,vc (563)583-1040/EMAi� tsteckle@cityofdubuque.org �! _ LL�'C�� . 1�'r°^, (�a. �Ccn.c-a_... CLAIM AGAINST 'THE CITY f�F D�TBUQUE, IOWA—c"• K�-�,�`" This written report �onstitutes your claim against the City of Dubuque, lowa. You should complete this form in full and attach �ny additiQnal information that � supports your claim. � filed with the Cit Clerk at Cit Hall, 50 W�st 13t" St„ � � The claim must be y Y Dubuque, IA 52001. It will then be referred to �the a�propriate 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 repork and recommendation. I I The final decision on all claims is made by the City Council. No employee of the � ; City of Dubuque has the authority to makQ any representation to you as to � whether your claim will or will not be paid. j ,�'% � 1. Name of Claimant: `J �-�Z�'i(-��" ��1��--r � 1 [�y�>�1 (,() .�" ,� IIjI 2. Address: �-I� � '�"^ • �7�� 'u �(�� I 3. Telephone Numbsr � -( /� � '�� ' � 4. Date of Incident: � �' �--�� 7 ;r , 5. Time of l ncident: �. � ��.�... �AZr�-fr7� ��.,.-�-c,��..�� .��l��r� "��C`�,�� 6. Location of Incident (Be specific). ` ��-�z G�.��"�` �� t t� ��,. � ��I 2- �.�b�C,�St�� e�` i�ia�:`�'i�t . G � � ��..� ,. .�J�� "� � 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 � ernp oyee's ame.) �.... ��,.� �� .��[ f1��'�;:�.. 1��. �`��'r ��i`r��-c�e�� '� r' ��l� ��.L "�fi�� e. �r{,"' � � d , �d.��°� �..cs l ��6�C" �� ✓ �r , 9.�� r " � 8. What were weather conditions like? �� -d �c� j � �� Rt Q. GivP, n�rn� �nd � dress �f any �iitnessPs: . 1�1 r�C�i��.> �f� ��a��,�l s�-�� a�� '� �.. ,�� d � �e'�.... C>- P�r�c:.�..�a L�� d'�'��ac c�� '�--. 10. D�id police investigate? (If sc�, ive names of officers.) ' �� .�- G'1�� '�� `" ��- C�v,�°��'.. � �-�r�:� �.�� ;� �� b �� ..� 5��.�� - �.� � � ��~� � ��~ 11. Was anyone injured? (If so, give names, ac�dresses, and exten� of injur}'es). I'�b ��...- �� I��k� e �"l�t.�... Ci�12..- �� i �p,�� Q�'d12�'�'�c� 12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of damages or de�cribe basis for ascertaining ex ent of damage.) � d�1 ��. �� l��a�- � �-- G'l��. f.�,� =�� 13. What other damages do you daim, if a�y? " ��.,. �� -- c�v;cl� �� /,�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 am unt paid:) - � �� -- �1��---1�� ?� � ��.�. ��c f��r�i��.. �.��'Y1 (p w� _ 15. What amount do you claim from the City of Dubuque? �`°� � . � � - �;1� �� r�t t��l�zre.��, ,� . Why do you claim the City of Dubuque is responsible?L� '(�a��. rd'1 ��- l�'?� ��;�,�1, c Jtl �.f�� 17. Have you made any cl�im against anyone else for damages as a result of this incident? (If yes, giv� 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? � j � I��G �.a d this �� day of d��°21�'�A~ , 20�. —� � � -�a ="' � �-- r� ', ,�t `' �' � Si nature , �~' ��' '`� ( ) . � �a�; � �� =�'I f��t.t�' ��j p�� a�� :;,� (Print Name) -�'�"�'� � �� _� �: � �� i Confidenti�i � This communication and any attachrnents may contain information which is confidential ! and privileged by law and is for the use of the d�signafed recipient. If you are not the i; intended recipient, you are h�reby notified that you have received this communication in I', error, and that any review, disclosure, dissemination, distribution or copying of its contents �I is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of i your receipt of these items and destroy the communication and any attachments r, immediatefy. Further disclosure o# this information may violate state and federal restrictions. � � ;, � Confidential information may include the following: � � � � 1) Social Security Number(s) 2) MedicaVHealth Information � � 3) Personnel/Disciplinary Information � 4) Bank Account Information 5) Financiallnformation 6) Credit Card Numbers , `I 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 I, , hereby certify that the attached documents � include the following protected information: � G Social Security Number(s) Bank Account Information � � Medical/Health Information Financial Information � , �, Personnel/Disciplinary Information Gredit Card Number(s) � ; t 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. � � � G Signature Date I have read�the information above and do not have any confidential documentation to submit to the �,�ity of Dubuque as p�rt of this,Claim Against the City � ��'`�'�"�f�'�,,,' �.' "��°�``� ��~f � `� ` � , Sig ature Date � � � Copyrighted December4, 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 lowa, the agent for the lowa Communities Assurance Pool: Donovan Properties, LLC for property damage; and Ramona Fraction for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referral Supporting Documentation TFiE CTTY OF � �� V� � � L � 0 1\ A 1 \ � V � Masterpiece on the Mississfppi TRACEY STECKLEIN JL.t�' PARALEGAL ��, �l To: Mayor Roy D. Buol and Members of the City Council DATE: November 17, 2017 RE: Claim Against the City of Dubuque by Ramona Fraction Claimant Date of Claim Date of Loss Nature of Claim i Ramona Fraction 11/17/17 09/28/17 Vehicle Damage � , This is a claim in which claimant alleges that a tree branch fell onto and damaged her h vehicle while the vehicle was parked in front of 2112 Jackson Street. This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance PooL I i cc: Michael C. Van Milligen, City Manager Steve Fehsal, Park Division Manager - Tom Kramer, Urban Forester Ramona Fraction OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/Fax (563)583-1040/Ennai� tsteckle@cityofdubuque.org � � 9