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Claim by Kendall Lee Coulson Copyrighted February 19, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Bard Materials for property damage, Kendall Coulson for vehicle damage, and Jeff Kintzle for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Claim by Bard Materials Supporting Documentation Claim by Kendall Coulson Supporting Documentation Claim by Jeff Kintzle Supporting Documentation ��I _ � � g � �LAIl1�I A�AIN�T 'I'�IE CITY f�F I��BIT��TE, IC}�VA �;�� . This writter� report consti�utes your cl�im �gainst the Cifiy c�f Dubuque, Ic�wa. You �� should complete this f�rrn ir� full an� at�ach �ny addi�i�nal infc�rmatic�n that sup�c�r�s yc�ur claim. The claim must be file� with �he City Clerk at Ci�}r Hall, 50 W�st �3th St,, Dubuque, 1A 5200�. [t will then k�e referred ta �he apprapriate department fic�r '� investigation and �o the �ifiy Attorney's OfFice. Onee that ir�vestigation is complefied, a report and rec�mmendatiar� will be submif�ed tc� the Cifiy �c�uncif, You will be provided with a cc�py of that report and r�cc�mmendation. The fir�al decisian an all claims is m�de by #he City Council. No er�p�oyee af the City af C�u�uque has the aufharity to makQ any repr�sentatian fio you as to ;� whefiher your claim will or will no� be paid. � , 1. N�me of C(aimant: �� '..,�"�` �'��'.��s��,.1 � ! 2. Address: � l�� "` �`"` 1��`�..� ,�� t�� Ik 3. Telephor�e Numb�r��r-��?�� 4. [�a�e of Incident: �c�tf�� iI 5. Time of Inciden�: � ��'�� . �ocation of Incident (Be specific): � � c��"" �" -�� ,� � �� 7. C��scribe �he aeeid�r�t c�r accurrence that caus�d ir�jury ar damage. {Give full � details �pon which you base y�ur claim. If a City employee was involved, giue fihe �mp��yee's name.} � � ��t � �'.� ,� d� � r� � � � S. What were weather conditions like? �t.�'�"�"" ,�al�.s��+rr � 9. ��v� r�ame ar�� ddress o��ny�itn�ss?G: �� f f F7t i 10. Did pc��ice investiga��? {If sc�, give names of affic�rs.} � �� s � 11. W�s anyone irrjured? �If so, give r�ames, ac�fdresses, and e�ctent of injuries). �� 12. Was any damage done �o prc�perky? (If st�, de�cribe prc�perty and fihe extent of damages. Atfiach es�imates c�f damages ar describe basis for ascertair�in� exten� caf damage.} C. t�, � � � _� �" �, � '��t`a�"c� 'z��--�- f�:� ��-�' � � � �{ � � �3: What other da�.nages do you claim, if anY? � ��A�.�'. 14. NaVe you been compensated for any part ar all c�f yaur claim by any � insuran�e cc�r�pany? �If so, giue r�ame and address ��F ir�surance comp�ny �nd am�unt paid.} � ��e � � � � 1 . What �maun� dc� you �laim �frc�m �� Ci�y �f C��abuque? � c� �:�"�� 1fi. Why do yc�u claim the City of Dubuque is respc�nsi�le? � � �' � �' �� Q � �°" R %. � 5 �"�� '�c� � � '�7. Nave you made any cfaim ag�insfi anyone els� for dam�ge� as a result �f � this i�cid�nt? (If yes, give name and address.} � �'� ._ k > � 18. If the ar�swer to Question �7 is yes, have you receive� any paymer�� frr�m tha� sc�urce, �nd if so, in what arnc�unt? �� ' �.�� -, r�; fg � �. Qc'��.'� ��'IIS . ��l'� {�c��1 0� �"�__�.��s�� 7 �� t _.` �-*� i Yf ��.. _ �� n �' °`� �,..� {Signat�re) � � � � ��" ��c��,� � {Prir�t Name) � � � I � � Co��`idf'nti�l This communica�inr� an�i any atfachrnents may contain information which is cor��der�tial ar►d privi0eged by law and is �'ar tl�e use of the ��signa�ed recipient. If you are not the intend�d r�cipient, you are hereby nc�#ified that ys�u h�ve received this communication �n � error, and that any review, d�sclosure, disseminat6or�, ddstribu�ic�n or copying c�� fis cantents G, is proh�bited. Ple�se notify City of Dub�aque imrn�diately by telephone at (��3}-589-4120 of � y€��ar receipt vf these items and destroy the cc�mmunicafiic�t� and any at�achments � immediately. Ft�r�her c�isc[c�sure af this inform��ic�n may viol�te sta�e and federal restrictians. � . � Confident�al infarrnatic�r� may include the fallQwing: � � � 1) Sc�ci�1 Security Nurnber�s) n 2) MedicallHealth lnformafiior� � � � � 3} Persor�r�e[1C}isciplinary Infiormation �� 4� Bank Acct�t�r�t Informa�ic�n � � � � � � ��'; 5) Fir�an�i�llr�fc�rmatio� 6} Credit Card Rlumbers � If any dgcumentati�n yoc� d�sire to s��mit to the Cifiy c�f Dubuque c�ntains any c�f the items above this cover sheet rntast be attached dire�tly to the cor�fident�al inf�rmatifln and indica�e the type c�f �nformation that is included. ; 1, , here�y certify that th� attached documents include the foll�win� protected in�c�rmation: � � Sc�ci�l �ec�arity Num�er{s) E3artk�1c��unt Ir�f�rr�a�ic�n � � h Medical/Nealth Informatic�n Financi�l Infarmation 1 k �'ersonnel/Disci�lin�ry Ir�f�rma�io� Cr�dit C�rd Nt�rnber(s} I ur�derstand th��his informatiar� may be distributed within fih� C�ty organiz�tion or t� a�er�ts of the City fi�r proce�sir�c� and I hereby aufihorize fihe Gity to act according[y taking a!I precau�ic�ns ta pratect my informatic�r� from unnece�sary distribution. � Signature Date � ! , I hav� re�d th� infiorma#ion above ar�d do nofi have any confidential documentatic�r� ta s�abmit tc� tf�e ° City of Dubuque as parfi of this Claim Ag�inst �he City �'�.,�'.��.�.__.. �/��' , Signature Date � � � � s � Copyrighted February 19, 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: Bard Materials for property damage, Kendal Lee Coulson for vehicle damage, and Jeff Kintzle for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation � � THE CTTY C?R �.TB � MEMORANDUM Mc�sterpiece on the Mississippi i TRACEY STECKLEIN �,� PARALEGAL ' i � f To: Mayor Roy D. Buol and Members of the City Council i� DATE: February 14, 2018 ! � � RE: Claim Against the City of Dubuque by Kendall Coulson � iJ Claimant Date of Claim Date of Loss Nature of Claim i � Kendall Coulson 02/13/18 02/04/18 Vehicle Damage �I� This is a claim in which claimant alleges that as she was backing her vehicle up near the g Lock and Dam, she struck a rock and damaged her car. �r This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa u Communities Assurance PooL cc: Michael C. Van Milligen, City Manager � Marie Ware, Leisure Services Manager Kendall Coulson � � OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 � TE�EaHotvE (563)583-4113/Fax (563)583-1040/Ennai� tsteckle@cityofdubuque.org � � w