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Claim by Victoria Ruefer 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 �1 _ � (�^. �'' ��c�� CLAIM AGAINST �t'HE CITY f�F l��JBU(ZUE, IOWA This written report ronstitutes your claim against the City of Dubuque, lowa. You should complete this form in full and attach ?ny additional information that supports your claim. The claim must be filed with the City Clerk at City Hall, 50 W�st 13t" St., Dubuque, IA 52001. It will then be referred to �the appropriate 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 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 makp any representation to you as to i whether your claim will or will not be paid. � � � t �' 1. Name of Claimant: e� i � 2. Address: � -�'�//� („r,� p �� ! � �I 3. Tele hone Number r � � 4. Date of Incident: / ' �� —'� � �� { � 5. Time of Incident: �a�� 1 � __ � 6. Location of cident (Be specific): � (' �e . 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 the r�ployee's n�ar'ne.) �/� � /�l.�/�� i\ �/i/I�tP�W� /'/��/�!��, ��' Y /J�� 0 �f��.'�" �/'"�1 � � � " � •`��t' F�. Q s � Tu /[ 9 � � //^, f �` ' � ...0 eLI.� � ' ^ N � / d 8. What were weather conditions like? /' m � ��,��s .�y 9. Gi��P ramP an� ��dress �f any witnesseG: � /`� 10. Did lice investigate? (If sc, give names of officers.) P 1�f�one injured? (If so, give names, ac�dresses, and extent of injuries). 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.) ---�>� �� 13. Wh t other damages do you claim, if any? � f1J i1- N � �1 � 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.) , e� ; �� — � I i 15. What amount do you claim from the City of Dubuque? � •--�' il F i G 16. V)(�y do you claim the City of Dubuque is responsi le? � ��i �-��. �vb��re �� • �s � i � /.e�.0�CS � 0 �// ` H � ✓ � 17. Have you made any claim against anyone else for damages as a result �f � this incid�nt? (If yes, give name and address.) � � W r; , � b � .�-� .� � 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? � r� �� Dated this o� day of `��k.�n , 20�. �--�s�� „ � � .��. �..� 'T'�� :-= �=.�� "� � �.� �- :... , � i F...� (Signature) „�� . { � % �,.... .�.0 ,:....� � � � e �,� �� =� -: �� (Print Name) ��' .� � � Confidenti�l This communication and any attachments may con#ain information which is confidential and privileged by law and is for the use of the designafed recipient. If you are not the intended recipient, you are hereby notified t6�at you have received this communication in error, and that any review, dasclosure, dissemination, distribution or copying of its contents ' is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of your receipt of �hese iterns and destroy the cmmmunication and any attachr�ents immediatefy. Further disclosure of this information may violate state and federal ' restrictions. �Confidential information may include the following: � 1) Social Security Number(s) 11 2) Medical/Health Information � 3) Personnel/Disciplinary Information � 4) Bank Account Information a� 5) Financiallnformation � j 6) Credit Card Numbers '' ,j h If any documentation you desire to submit to the City of Dubuque contains any of the items above j; this cover sheet must be attached directly to the confidential information and indicate the type of '�! information that is included. !� ;; � � I, , hereby certify that the attached documents �i include the following protected information: , Social Security Number(s) Bank Account Information �, Medical/Health Information Financial Information Personnel/Discinlinary Information Gredit �ard Number(s) 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. Signature Date I have read the information above and do not have any confidential documentation to submit to the City of Dubu e as part of this Claim Against the City � r Signature Date R+ 1 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 CTTY OF �. �U� E MEMORANDUM Masterpiece 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 Victoria Ruefer �� Claimant Date of Claim Date of Loss Nature of Claim � '� � Victoria Ruefer 01/24/18 01/23/18 Personal Injury � !� This is a claim in which claimant alleges that she feli an injured herself on an icy sidewalk il near 607 Rhomberg Avenue.. I� This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa ' Communities Assurance Pool. �� cc: Michael �'. Van Milligen, City Manager � Gus Psihoyos, City Engineer � Tom Kopp, Engineering Technician Victoria Ruefer ° � OFFICE OF TNE 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 � � �