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Claim by Amenda Loeffelholz Copyrighted January 3, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Merlin Atkinson for property damage; Amanda Loeffelholz for vehicle damage; Molly Skoglund for vehicle damage; SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Atkinson Claim Supporting Documentation LoeffelholzClaim Supporting Documentation Skoglund Claim Supporting Documentation DEC/1$/2017/MON 08;05 AM �D School Distri�t FAX No, 815-747-2111 P, 00�/006 �,_.., c.,, � I(`�1��1 �LAIM ,A�AIN�T TH� iC1T"Y +CJF 171,lBU(�IJ�, rC11N,A rn, ���� Thi� wri�er� report constitu�tes your claim a�ains# th� ��fy v� Dubuqu�, lowa. 'You st�ould � campl+�te this farrr� �n fuEl and attach any additinn�l inforrn�ati+vn�hat��app�ort�yaur�laim. � The ��aim must be file� with #he City Clerk �t�ity H�II, 50 W. ���h �t�} C1�buqu�, IA 52UO�f. !t v�►il! �h�an !a� r�ferr'+�d b� th� �Clxy Cc��ncil �E+� the ��propriate cl�p�r'fiment for investi�ati�n. [�n�� that inv$�ti��afiion is completed, a report a�1t1 w��crmmen��ti�� will be submltt�d fo the �ity C�un�il. You Will be provid�d with a c�opy c�f#h�t r�p+�rt and re�c�arr�menda�iQn. TI-�� FII�AL DECI$I�N ��l ALL �LAIM� IS MAQE ,�Y THE �ITY Ci'�UN�IL. NO EMPLUY�E t�F Tk-IE �ITY t]F ��IL�L1C��1� HAS THE �iJTHQF�.ITY TI'� M�►KE ANY F�EF�Fi��ENTATlQN 1'C? 'Y'�l� � A5 T�J WHETHER Y4UR CLAIM WlLL OR VNILL NOT B� PAIa. '1. Name �f+�Ia�mant: �Y..l��*-= �..�--��-��,�k���. - , � � �3� �� 2. Addr��s: �(�:aq �'�- ��'� � 1 , .� � 3. T���pf�an�e Numb�r: _��� �-��R r���a��J� _ � I 4. D��� ��Incid�r�t: ►�+' � " �� , � ���i ;� 5. Tir�rte �af Incid�nt: �•�� � p 4 7 6. �,o�afiion af Incid�rtt {Be specifi�}: ��� �+� - Y'� .�� 4"` � ;�- ; qL}('���, � 7. DES��IBE AC�II�ENT �R bC�GIJRR,EN�� THAT CAUSED IN,lUF�Y �3R 1]A�VIAGE. (�ive full d�t�ils upon wl�i�h yt�u ba�+� yc►ur �I�im. If a �ity emplo�y�� vrras ir�rr��v��d, give th� �n�pl+�y�ae�'s name.) �� _ 4�0� ���(L, �`�., ��'+ ��.�..���� E]� � ��� l.r.�S�r�,rn �" l,�r,�Y''�" �� l.�c�..�v� � C�.., rr,a..,� � ` � �C�c -� ��`e�. �e��r�.,�rr ap�-r. t`.,c�-�c• ��..�� ��.�- �[�� � ���, c�� �.�-c � �t�tG��c�� �.� '�� p��.� � - - $. What w+�re weather canditPc�ns lik$? { , � 9. (a'iv� name and a��lre�� of any witne�se�: � 4„�0� 'S�. .�,�..�,� �Q. �id polioe ir�v��tigaf�� (If st�, give names of a�FFi�ers.) '���`1G-,�,�r���, � ' 1'I. Was anyane injured? (If sc�, g�ve �ames, addre����, �nd e�f�nt o# injuries}� �� � � � DEC/1$/2017/MON 0$:05 ANI ED School Distri�t FAX No, 815-747-2111 P, 003/006 �I�. Vti1as any damage dane ta �rap�rty7 (If �cr, descrii�� prope�ty �nd th� �xtenk �rf dama�es. Atts�ch estirt����s of dam�,g�� �►r +d+e��crik�e� b�sis fc�r �scerfaining �xt�n� af da�2�g��.) �{� • � 13. What other damages do yau +�i�im, if any? '14. H�ve yau b�en �ccrrn�en�a�ed far any p�r# �►r all vf yaur �I�i�m by' any �nsurance campan�/? (!f�o, give name ar�d addre�� af in��uran�e �comp��ny and amau�rtt paic�.� � � � � � 7�5. Vllh���rt��unfi dn�rau ciaim from the �ity nf �ubuq��7 � � � 'Ifi. Wh�dQ you clairx� the �ity r�f bubuque is t'espon�ihle? 'I� � "�� 6 c� �} 6 ��,�.�'t�c�.t ��4�.�,r�,,'�� -�;�.t,s. '!7. Have y8u r�ade �n� �la�m ag�wnst any�ne else for dam�ges as a r�suit of this in�cid�r�t? (If���, give nam� and �ddre��,) 18. If �h�e answ�r �a Q�a�stion �17 ys yesr h�ve yau received any p�yme�nt fram that s�ur�ce, and if sa, in what�mounf? Gated at Dulauqu�, I�v+►a this !d�y c�f�p,�"�n �,�' , 20�. � , �Sign�ture� ��(�..Y1(�C�-.. �Q'�'.��•�a���2� (Print Name) � , . �;�`� �a ��;�� � � (Rev. 71�12) � '`�r � �� �� '� x � � �.� r E�� +w= rJ,�. � _ �� �� � �,..� � � ",�y � I , f � � R DEC/18/2017/�ON 08; 04 AM ED School District FA� Na, 815-747-2111 P, 001/006 � � ��n�idert�i�l A This communicatinn �nd a�ny a�tachmen#� may ��intair� inf�rmation which is confid�ntial � and �arivileged h�r law and is far the us+� o�f #�+� �l+��igr�ated r�cipien�. If you are not the � int�nded r�Gipient, X�vu �r� hereby np#ifi�d th�t y�u h�ve r���ivecl this comrr�unicati�an in 9 error, and that any review, [lis�lc�sur+�, diss+�min�tio�, �li�tributian c�r cc�pying af its cant�nts is p�rahibit�d. Rleas�e n��ify �ity �►f pubUque imme�i�#��y �y ��lephan� �t (�63)-5�9-4'120 of �our receipt +�f #h�se iterns an�f des#r�y xhe �c�mrrruni��ti�►n �nd ar�y attachment� immedia��ly. Further �ii��lasure of thi� infc►rmatic�r� may vivlat� �t�t� and f,�der�� ; r�s�ri�#ivns. �r�nfidentEal information ma�y include �}t��fc�llc�wing: ; � 'I) Soci�l �ecurity Nurnk��r(s) � �) MedicaflH�al�h Informatian II 3) P�r�e�nnetl/bisc�plinary Infarmatiar� � 4) �ank Acc�aunt In'Farm�#ion jl �) Financial Information II, 6} �re�dit�ard Numb�rs ; � If �I�y dracumentat'san you desir� fa su6mit to the Ci�y of Dubuque ccrntains� any of the items abov�, ; xhi� corler` �heet must b� attached direct�y� to the confid�nti�l information. F�lease indica�e below the ; type ��inform�ti�n that is ir��luded. I n �d I, �'t`�°+,[�.c�((};= �-�`����'�1��.. , hereby c�rtify tha� the attached dacument� include th�fcrllowing �rc�t�ct�d infarmatiar�: I� N �acial ���curity �lumb�r(s) B�nk Acco�unt Informati�n � � Medica1lHe�lth Inf�►rrr�atican Firtat��ia[ Inform�ti+�n fl � � �� Pers�nr�e�IfDi��iplin�ry Inforrrtatiar� ��redit C�rd �lurrib�r(s) � 9 � � � I underst�n� th�t this inf�rm�ti�n may be di�tribu��d within the City arg�nization Qr tp a�ents of th� � City far prace�ssing �nd 1 h�r+�by �uthqriz� th� City t� ��t ���c�rdin�ly taking all pr�cautic�ns to � prate�� my inforrn�tic�� from unne�e�sary�i�trib�ati�on. Signatur� D�t� [ i���� rea� �h� ir�farmation abQv� and �I� n�� t��ve any cQnfi��nti�l daaume�tatian tc� �u�mit t� �h� Gity c�f a�abuque as� par�af this� Glaim A�ainst the City. "'�� � Sigr��tur� � IDat�� 6 � k € � Copyrighted January 3, 2018 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: Amanda Loeffelholz for vehicle damage; Molly Skoglund for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation THE CITY OF I�'�,TB E MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL � � i � � x To: Mayor Roy D. Buol and Members of the City Council ° �, DATE: December 18, 2017 � � RE: Claim Against the City of Dubuque by Amanda Loeffelholz � Claimant Date of Claim Date of Loss Nature of Claim � �Amanda Loeffelholz 12/18/17 12/05/17 Vehicle Damage �� � �I This is a claim in which claimant alleges that a branch fell from a City tree onto claimant's % vehicle which was parked in front of 2410 Broadway Street. i; II This claim has been referred to Public Entity Risk Services of 6owa, the agent for the lowa F Communities Assurance Pool. , cc: Michael C. Van Milligen, City Manager Steve Fehsal, Park Division Manager Tom Kramer, Urban Forester Amanda Loeffelholz � 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/EMai� tsteckle@cityofdubuque.org � � �