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Claim by Molly Skoglund 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 �.,��,o �. .�� .�..�. �-�. CLAIM AGAINST THE CI'T'l� OF DUBUQUE, IOWA This written report constitutes your claim against the City of Dubuque, lowa. You should complete this form in full and attach any additional informafion that supports your claim. The Claim must be filed with the City Clerk at City Hall, 50 W. 13t" �fi., 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 o�FClaimant: t iJ�10 ` �t°°l � � � a � � 2. /�ddress: � . ��' � „ �. �� ; 3. Telephone Number: L �'�l � ' 4. Date of Incident: �� N 5. Time of Incident: � � ��Y"� � �� 6. Lo�ation of Incident (Be specific): a " � ��'� ' S1� � � ; � _ 1��'�, � _ i 7. DESCRIBE ACCIDENT OR OCCURREN�E THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. If a City employee was involved, give the � emplayee's name.) ��c� ' �1 �� \�� n�� 8. What were weath�r conditions iike? 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) � � f— � � �� 11. VVas anyone injured? (If so, give names, addresses, and extent ofi injuries). �� i 12. Was any damage done to property? (If so, describe property and the ext�nt of damages. Attach estimates of damages or describe basis for ascertaining extent of damage.) , � � `",� �' i� � � � i 13. What other damages do you claim, if any? � � � 14. Have you been compensated for any part or all of your claim by any in�urarrce u company? (If so, give name and address of insurance company and amount paid.) . ,� ��.�'�1��r��C��`� 1�,�,�;��..�.��a�� :�a��# � �� ►��c�� 15. Wha�t amount do you claem rom t�he City of Dubuque? _ ��.` r� ° f. � 16. Why do you claim the City of Dubuq,ue i� responsible? �� C��tr� ��r��`��1 � � �� 17. Have you made any claim against anyone else for damages as a result of this incident? F; (If yes, c,��ive name and address.) jr'�, 1�C� I'' �, 18. If �he answer to Question 17 is yes, have you received �ny payment from that source, �' and if so, in v�rhat amount? . � Dated at Dubuque, lowa this � day of ��(��l��(k� , 20�. � �' � � � c�e ,� r ► i_ � ��.( �n� ,nr , c� ry , � ��'s��«t�� / � _ , �✓ � � .��( �� lLt (Prir�t N�rr�e) � � � � � ; � � t.��''� r� ,_ r-._ c� 3"�mm� (Rev. 7f12) s� ` '� �xJ � �:� . ' r� �F •;' �,:, =�. :.G d`�.� �� €--�-� �;;:- ;;� `� ��.� c� �� I _ ,� �=A,.-T,�-. --�- - —:. - _�.,�,; ..�... ,.�---�-- _ _----- -- .�..�° r � StateFarm� ti ' '�'', "' U.S.POS�'AGE$��r►v�raou�s ; � State Farm Insurance Companies � A �� Prop E Office NEWK . ZIp�.gp�� 0 PO Box 52250 02 iYY � Q��'�� Phoenix,AZ 85072-2250 0003399�82�7E�. 93. 2t337. , i ' � /-�!✓' �hl �� y �f��s �� '� s� � � �� f �� a �� 6 i . , r . . _ _ . j . a ra �:t �-as �_ � r':t� r, €r� r� `�t�{�� .f : t ��2-:s ' �..�-,��::.�.�;=,:w = � � ,3� � � � � �� l � � ��' �� €� �� ' �� 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 CTTY OF �LTB LTE MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN � PARALEGAL To: Mayor Roy D. Buol and Members of the City Council � DATE: December 20, 2017 RE: Claim Against the City of Dubuque by Molly Skoglund, filed by State Farm Insurance Companies � Claimant Date of Claim Date of Loss Nature of Claim � � iVlolly Skoglund 12/18/17 05/17/17 Vehicle Damage � Filed By State Farm ;� Insurance Companies w � This is a claim in which claimant alleges that a City tree fell onto insured's vehicle which was parked in Flora Park. This claim has been referred to Public Entity RiskServices of lowa, the agent for the lowa Communities Assurance PooL cc: i�lr/lichael C. Van Milligen, City Manager � Steve Fehsal, Park Division Manager � Tom Krarner, Urban Forester State Farm Insurance Companies @ � 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 9