Claim by Alex Helbing Copyrighted
March 5, 2018
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Alex Helbing for vehicle damage, Kathleen Pfohl for vehicle
damage, TFM, Co./Tom Thompson for property damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City
Attorney
ATTACHMENTS:
Description Type
Claim by Alex Helbing Supporting Documentation
Claim by Kathleen Pfohl Supporting Documentation
Claim by TFM, Co. Supporting Documentation
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CLAIM AGAINST TWE CITY OF DU�UQUE, IOWA ���c�
This written report constitutes your claim against the City of Dubuque, lowa. You should
�omple#e #his form in full and attach any additional infrarmation that supports your claim. . I'�
The Claim must be filed with the Cafiy Clerk at City Hall, 50 W. 13r" St., Dubuque, lA 520A°I. It j
will then be referred by the City Coun�il to the appropriate depar�ment for investigation. '�,
Once that investigation is completed, a repork and r�commendation will be submitt�d to the ;
City Counail. You will be provided with a copy of that repart and recommendation. 'I
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THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY+COUNCIL. NO EMPLOY�E C)�' ��
THE CITY fJF DUBUQUE MAS THE AUTHORITY TO MIAKE AIdY REPRESENTATION T4 YQU I�
AS TO WHETHER YC)UR CLAIM WIL.L t�R WILL NOT BE PAID. !I
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1. Name of Claimant: � �' � i
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2. Address: L- � �,� ��� '�;
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8, Tele hone Number: 'i
4. Date of Incident: � ���, ��� �
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5. Time of Inaident: ,��°� '� �`i�
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G. Location of Incident(Be specific): �... �°'Tv ��.,�.�Si c�� , ,
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7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give �
full details upon which yora base yaur claim. If a City emp►loyee was invoMved, give th�e �
emplayee's name.) �
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8. What vuere weather conditions Ni�Ce? ���� 3� �� �
9. Give name and address of any witness�s.
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10. DId police invesfiipate�' (If�o, aivs names of officers.i �
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11. Was anyone injured? (If so, give names, addresses, and exfient af injuries).
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12. !lVas any da�r�ge dane to pra�ae�fiy? {If �so, d�scribe propert�r and �he e�ent of �
t�amages. At�a�h estimates of d�mages or +d+�scribe ba�os for �sc�rta�nir�g exfient c�f
damage.) ;
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1�. Wha�o#�e�r darn�c�+�s dc�y+��a ���im, if any'� �
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�14a Have you bee� comp�r��at�d fiar any p�rt sar a!1 of your ci�im by �ny Nnsurar��e "'�
c�m�ar�y'� {If so, give n�me �r�d addr��s c�f i�nsura�nc� �ornpany and amaurt� p��d.} �
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75. �hat�rnc�u�dc�you cl���ra�r�m�he G�ty af�ubuq��'� �
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16. Why do yvt� �I�irn th� City o�f��bc�que is responsible?
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77. H�ve you �ad� any claimi �gainst anyane ��se for dama��s as� res�zit+�f tt�is in+�id��t��' �
{I#yt�s�give nar�ne an�l at�dress.} `
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1�, If the answ�r tc� Questi+�n 1? �� yes, have you r�ce�ved any payment fram that sc��rce, ;
and �f so, �n what�rnoe�nt? �
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D�t�d �t D�buque, lowa�his ��d�y t�f �-�'��`� t , 2�1� . �
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'�his �omr»e�r�ic�tion and any �fita�chments may cant�ir� infc�rmation whi�h is conf�dentiai �
a�d priv�t�g�d by taw and �� fc�r th�� t��e of the desi�nated recipient. !f you are nc�t th� a
intended r��Ep�ent, yuu ar� hereby nvt��i�d that yc�u have receiv�d this cQmmunicaticrn in �
errc�r, a�d t�at any review, c�i��lc►sur�, d�ssemination, di�tribution or ce�pying c�f ets c+�ntents �
is proh�bi���l. Please notifiy +�ity a��` Dubuqu� immediately by tele�shone at {���}-589-4'120 af !
your rec�ipt of t1��se ��ems �nd destray th� cc�mrr�un��c�tion and any �tt�achrn�n�s C
immec�i�fiely. ��arther dis+closur� c�f th�� inforrnatiar� m�y violate �tate and f�der�l z
resfiricti+�n�. �
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�r�nfidenti�l inform�tion may inc�c��t� the�Follc,wing: �
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1) �ocial �ecurlty�l�mb�:r{s) �
2} Medic��ll�ea��1� �nfQrmataon � �
3) Per�c��nei/Disciplinary Infiarm�tic�� �
4} E�artk Account 1nfc�rmation
�} Fin�nci�l �r►fc�rmation
�} Cr�dit Card Numb�rs I
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If�ny dac�menta�ic�n yQu d�sire tc� �ubmit�o th� Ci#y of C�ub�que �onf�ins ar�y t�f#he item� alac�ve, �
this cav�r sh�et must be attacF��d directly��the cc�nfidenti�l ir�farmation, Ple�se indic���belt�w th�
tYpe c�fi infr�rma�it�n that is incl�aded. �
1, , h�r�by cerkiirCyy th�t th� �tt�ch�d de�eurrter�ts �
inc6ude��re fc�llowir�g pt`��ec��d infr�rm�tian,
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Sa�i�l Securifiy Nt�rr�b�r{�� �B�nk Acccxunt lnform�tiort �
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IV4edi�t/Heal�h 6nft�r�natic�n Fin�nci�l Information �
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PersannelOD��ciplinary In�arm�#iQ�n �r�dit C�rd Numk�er{�) �
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9 t�r�d�r����d fi'���tni� ir���i���i�rt ��y b� di��ribi���d v�ri�h�i� �h� �i�`y c�����;z€�iiv� ur te��t�+��t�tr��i� ;
City for �ra�essir�g an� � her$f�y ���hc�ri�� th� City tc� act a��ordin�ly takinc� �I� pr�cautions �� �
p��ect my irtforma#ic�n frr�m unrre��s��ry disfrilaut�on,
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Si�natur� C��t� �
i have read �he mformat�an abov� �nc� d� rrot have ar�y con�dent'al dc�cumentat�ar� �c� suk�m�t to the
Gity of Dut�uque a� part of fihis Cla�m A�ain�t#he City.
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�ignature Da��
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Copyrighted
March 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: Alex Helbing for
vehicle damage, Kathleen Pfohl for vehicle damage, and
TFM, Co. for property damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Staff Memo
THE CITY OF
�UB �� CTE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN �
PARALEGAL
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To: Mayor Roy D. Buol and '
Members of the City Council
DATE: February 27, 2018
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RE: Claim Against the City of Dubuque by Alex Helbing ��
Claimant Date of Claim Date of Loss Nature of Claim II
Alex Helbing 02/27/18 02/14/18 Vehicle Damage hl
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This is a claim in which claimant alleges that a city bus struck claimant's vehicle which t;
was parked near Hill and 9t" Streets. �
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This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa ;
Communities Assurance PooL �
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cc: Michael C. Van Milligen, City Manager a
Russ Stecklein, Transportation Services Field Supervisor �
Alex Helbing ;
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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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