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Claim by Michael Gukeisen Copyrighted February 5, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Robert Apel for vehicle damage, Carol Bandy for personal injury/vehicle damage, Jenny Cook for vehicle damage, Dubuque County Sheriff's Office for vehicle damage, Felderman Business Associates for property damage, Michael Gukeisen for vehicle damage, Joseph Ray for vehicle damage, Victoria Ruefer for personal injury, SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Apel Claim Supporting Documentation Bandy Claim Supporting Documentation Cook Claim Supporting Documentation Dubuque Co. Sheriff's OFfice Claim Supporting Documentation Felderman Business Associates Claim Supporting Documentation Gukeisen Claim Supporting Documentation Ray Claim Supporting Documentation Ruefer Claim Supporting Documentation �� '� C�AIM AGAINST THE CITY C}F DUBUGtUE, fOWA �� t�� 1"his written r�port constitufies your claim against the City of Qubuq�ae, lowa. You shou �� complete this fc�rm in futl and attach any additicrnal infc�rmatian that suppor#s your claim. The C[aim must be filed with the City Clerk at City Hatl, 50 W. 13fh St., Dubuqu�� [A 5z{I01. It will then be referred by the Cifiy Cour�ciC to the appropriat� department for investigation. t�n�e that investigation is completed, a reporfi and recommendation will be submitted �te the Cifiy Cour�cil. You will be pravided with a cc�py r�f that repart and recomrnencfa�ian. THE FtNAL �ECISIC?N t3N ALL C�A,IMS !S MA►C�E BY THE CITY Ct�UNGIL. NfJ EMPLOYEE OF THE CITY t7F DUBUQUE HAS TNE AUTHt7RITY TU MAKE ANY REPRESENTATItJN TO YOU AS TO WHETHER Yt}UR GLAIM WILL 4R WILL N{JT BE PAID. � 1. Name of Claimant: ''� � .- e�' '"'�� _ a" 2. R��t�r�ss: �� r �"' � �..` ,�' 3. Telephs��ne ��ber: � � -- ��"`�� -� �r�i�' �'�_"``�'� 4. Date of Incident: � � �� / � 5. lime of Incidenfi: �� 6. l.ocation of Incident{Be specific). --�� --°� � �� ' 7. C}ESCRIBE A�CIDENT C'�R t�CCURRENC� THAT CAUSED INJURY OR DAMAGE. (Give full details upon which ya� base your claim. If a City employee was involved, give the �as�pl€��ee'� ra��,�.� . 1^ �'° �� 'Jt,� �� !'"'� v' �" e` �� ! 8. What were weather conditions like? � � ;...� �-? i 9. Give name and address af any witnesses: � :�'.�"? � ' 10. C►id police investigate? (If so, give names of officers.) ' �-",��-r�7�'?G�' ,�"d.� �� { '1�. Was anyone injured? {If so, give n�mes, addresses, and extent of injuries). � _--�''� , i � � � i 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.) , . .� -"'� �� f � �',�'" �^ f-^.� �'�Z. / / . ,� J/`� �-�%-�/ //(/!" . � .S 4�/1 L� r _ .�"� �9 G°/J�., V 4� 13. What other damages do you claim, if any? �'`"7/�,� Jy .�� 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? ��'�S,=�S'- ?,� 16. Wh I do you claim the City of Dubuque is responsible? , � 17. Have you made any claim against anyone 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, an�d/if,�°o in what amount? 1G'/� �� / Dated at Dubuque, lowa this��day of G� rl�,�'✓^t� , 20 J � � � / r �� -�� (...;��`^'�''—.�---�. (S i g n atu re) � i' -C� �- ��1i2�� _ (Print Name) �� _ , �� I � � �� ''�7 - � j , � � �� (Rev. 7/12) - - �� `'� � `�'' �.� � ,µ��-� i � 4"Y `I"�= ": t �w _ " � � `�'4w9 7�.L� � �� ' Copyrighted February 5, 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: Robert Apel for vehicle damage, Carol Bandy for personal injury/vehicle damage, Jenny Cook for vehicle damage, Dubuque County Sheriff's Office for vehicle damage, Felderman Business Associates for property damage, Michael Gukeisen for vehicle damage, Joseph Ray for vehicle damage, Victoria Ruefer for personal injury. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo � THE CITY OF � I��,TB � MEMORANDUM Master�iece on the Mississippi TRACEY STECKLEIN -� PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: January 24, 2018 RE: Claim Against the City of Dubuque by Michael Gukeisen ;; �, Claimant Date of Claim Date of Loss Nature of Claim '� � II Michael Gukeisen 01/23/18 01/14/18 Vehicle Damage � This is a claim in which claimant alleges that a city snow plow truck struck claimant's i� vehicle near 566 St. George Sfreet. ; ; This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance PooL � cc: lVlichael �. Van Milligen, City Manager � John Klostermann, Public Works Director Michael Gukeisen , � 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� (563)583-1040/EMai� tsteckle@cityofdubuque.org B