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$/2017/MON 08;05 AM �D School Distri�t FAX No, 815-747-2111 P, 00�/006
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�LAIM ,A�AIN�T TH� iC1T"Y +CJF 171,lBU(�IJ�, rC11N,A rn, ����
Thi� wri�er� report constitu�tes your claim a�ains# th� ��fy v� Dubuqu�, lowa. 'You st�ould �
campl+�te this farrr� �n fuEl and attach any additinn�l inforrn�ati+vn�hat��app�ort�yaur�laim. �
The ��aim must be file� with #he City Clerk �t�ity H�II, 50 W. ���h �t�} C1�buqu�, IA 52UO�f. !t
v�►il! �h�an !a� r�ferr'+�d b� th� �Clxy Cc��ncil �E+� the ��propriate cl�p�r'fiment for investi�ati�n.
[�n�� that inv$�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���. - , �
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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.)
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- $. What w+�re weather canditPc�ns lik$? { , �
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���,
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1'I. Was anyane injured? (If sc�, g�ve �ames, addre����, �nd e�f�nt o# injuries}�
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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��.)
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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�.� �
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7�5. Vllh���rt��unfi dn�rau ciaim from the �ity nf �ubuq��7 �
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'Ifi. Wh�dQ you clairx� the �ity r�f bubuque is t'espon�ihle? 'I�
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��,�.�'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�.
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DEC/18/2017/�ON 08; 04 AM ED School District FA� Na, 815-747-2111 P, 001/006
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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: ;
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'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 ;
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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
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I, �'t`�°+,[�.c�((};= �-�`����'�1��.. , hereby c�rtify tha� the attached dacument�
include th�fcrllowing �rc�t�ct�d infarmatiar�: I�
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�acial ���curity �lumb�r(s) B�nk Acco�unt Informati�n �
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Medica1lHe�lth Inf�►rrr�atican Firtat��ia[ Inform�ti+�n fl
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Pers�nr�e�IfDi��iplin�ry Inforrrtatiar� ��redit C�rd �lurrib�r(s) �
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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.
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Sigr��tur� � IDat��
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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 �
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To: Mayor Roy D. Buol and
Members of the City Council °
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DATE: December 18, 2017 �
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RE: Claim Against the City of Dubuque by Amanda Loeffelholz �
Claimant Date of Claim Date of Loss Nature of Claim
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�Amanda Loeffelholz 12/18/17 12/05/17 Vehicle Damage ��
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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;
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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
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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
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