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Claim by Progressive Northern Insurance / Andy Bartolotta Copyrighted April 2, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Progressive Insurance Co. /Andy Bartolotta for vehicle damage, Jordan Roberson for vehicle damage, Lloyd Haywood 3rd vs. City of Dubuque Police et. al. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Progressi� Insurance Co./Bartolotta Claim Supporting Documentation Roberson Claim Supporting Documentation Haywood vs. Dubuque Police Suit Supporting Documentation P3 �I�� hC��'� � � �� C�.AlM AGA,It�ST TH� ClTY OF �U�UQUE, IC11NA � � �This written report cc+nstitutes yo€�r claim against the City of a�abuc�ue, lowa. Yau should complete tl�is faem in full and�aitach an�aciditir�naf infarmat�an t�at sup�aorts your�fa'[rn. � � TF�e Ctaim rnu�t be f�Eed with the Cifiy�I�rtc at Ci#y Hall, 50 W. 13m �t., Dubu�ue, IA 52Q01. I# will tl�en t�e r�f�rr�:d by #he City CounCil to the �pp�`o�ri�te t�ep�rtment for investig�tion� CC�f7G��IC1V+�S�IL��1013 IS GO�i'lpIE�6CI, a repart and recommendatian wv�il la� subrr�itted#o#h� City Caunc�l. You wi[I�ae �ravided witF� a copy of that��port and r+ecom��ndation. TH��INAL.�ECI��C►N ON ALL CLAIMS !S MAC1E BY 7HE CITY COt�NCIL. NC1 EMPLOYE�OF � TH� CITY OF L]UBUQUE HAS THE Ai�THORITY TU �AKE ANY REPRESEh1TAT�ON TCl YOU 1 AS TD WHETMER YQUR GLAtM W1LE.QR WILL NaT BE PAID. ;I �'� '�. �ame of Glairnant: l�rogressive North2m Insurar�te C�impBrt�8/s10 BARTC7LOTTA,ANDY � 2, Q('�(��'�g$: PO BOX 592929 LOS ANGELES,CA 90�51 �i i 3. Tel�phane Number: 4dQ-91p-582$ i Iq I j 4. �ate o�Ittcidertt: n,_a�-,R � li rJ, TICl7@ Uf�t7C1(�E�i7$: S�nn PM � �. �.oGatir�r� of Incicient��e speci�ic}: us a�a��sr,ar�r�wi-nr�s7 i�nuBuc�u� ,I� � � 7. DESCRiBE ACCIDEhiT OR OCCURRENCE THAT �AUSED tNJURY C�R DAMAG�. (Give � fu11 details upon wh�ch yc�u b�se yc�ur ciairn. !f a G��yr empEo�ree was invtalved, give the � emplayee's name.) dur named insured's 2�15 Chevrolet Si4veeado C35�0 wss fravelir�g noRhbound in the Ie�E 3ans on White St.with a green light at ths interseciion with E.9Th St„ w , , , . ed our insured's vehiate.'T'he driver,Brad Strannon,is the proximate cause of this acciden#due#o failure to mainiain pr4per IaoEcout. 8, What were we�ttr�r condi�ic�ns li�Ce? 9, Give name and a,�dre�s a#any wit�esses. 10. �id police inv�stigate? (If so, �fYB t"k�tTt@S 4f O'�lC@fS.) � rn�t��n�iF pn R�pnR`r�9n�snnma!a �17. Was anyone injt�red? (If so, giv� names,addresses, and extent of injur�es). CIi�URN,E3f�A�3DY-RIBICHEST CDNTUSIONS,SOFT T15SUE SPRAiN1STRAIN � � P4 12. Was any damage done to propErty? {If sa, describe praperty and the extent of darr�ages. Attach estimates of damages or describe basis for ascertaining extent of damage.) 15 CHEVROLET SELVERA�p C1500K1500-FRONT,UNDERBODY 13. What other damages do you ciaim, if any? 14. Have you been compensa#ed for any part or att of your c(aim by any insurance company? (If so, give narr�e and address of insurance company antl amount paid.) Progressive NoRhern Insurance Company 13,624.99 15. What amount dv you claim ftom the City of Dubuque? 13,624.99 Ou�n�amewn��red�26T5�Che�vro�et S1v�er��a��T50D waDs tra�vslii(gunort�boued�i ifie Ee�Ia�nQe on Whita St.wi[h a green light at?he intersection with E.9Th 5t.. w , , ed our Insured's vehicle.The driver,B�ad 5hannon,is EY�e proxirna#e causa of ihis accident due to failure#o maintain proper 600koat. 17. Have you made any claim againsf anyone etse for damages as a result nf this incident? (If yes, give name and address.} 18. [f the answer to �Que�tion 17 is yes, have you received any payment from that source, and if so, in wha#amount? 5�?�I�4;��F��h��AY�IFLD F�FS OH 44124 Dated at�qtr�;lev�e this z'��--day of �c.�°�°�,., , 20� r M �._��i�� _ / ! ....... . ....� — --, E��y�ia4�7�CJ � �� a � � ��L*��r�> � � ��`�........ (Print Name) �:; L,� .xs (R�v. 7112� -- _=: � ,...�,- � � - �� -,-� ,y. . ,;: . _.,, i:=, , . - ,_;_, _ � � ; . .. �.J ..`.. �i �1, � CiZ �� P1 ��+�.WI�� Payment Address Document Address 24344 Network Place P.O. Box 512929 Chicago, IL 60673-1243 Los Angeles, Ca 90051 Phone: (877)818-0139 Fax: (888)781-6947 3/19/2018 2:51:00 PM Certified Mail 91 7199 9991 7037 9064 1063 Return Receipt Requested CITY OF DUBUQUE CITY CLERK'S OFFICE CITY HALL 50 WEST 13TH ST. DUBUQUE, IA 52001 Your Client: SHANNON, BRAD Your Claim Number:n/a Our Insured:BARTOLOTTA, ANDY Our Claim Number:18-5505165 Amount Subject to Reimbursement:13,624.99 Amount of Insured's Deductible: 1,000.00 Please take this as formal notice of our subrogation rights relative to the above -captioned claim. We have completed our investigation into the facts of the above-captioned loss and find that your insured was the proximate cause of the accident. Location of Loss: US 2 E 9TH ST IN DUBUQUE Date and Time of Loss:01-26-18 AT 8:00 PM Description of Loss: Our named insured's 2015 Chevrolet Silverado C1500 was traveling northbound in the left lane on White St. with a green light at the intersection with E. 9T" St., when a City of Dubuque Police 2017 Ford F150, plate number 501204, was traveling eastbound on E. 9Th St. and ran a red light and struck and damaged our insured's vehicle. The driver, Brad Shannon, is the proximate cause of this accident due to failure to maintain proper lookout. Please make your draft payable to Progressive Northern Insurance Company as subrogee of "BARTOLOTTA, ANDY", in the amount stated above and mail it to the attention of the undersigned at your earliest convenience. AI upporting doc�.imentation is enclosed. I have diaried my file ahead fifteen (15) days. Thank yo for ur anti ip ; , prompt attention to this matter. z' ��.;�� '1.�, Richard �erlan �'� Subrogation Representative Progressive Northern Insurance Company Tel. 440-910-5828 Fax. 888-781-6947 richard w_berlan@progressive.com 1 Con�dential This communication and any attachments may contain information which is confidential and privileged by law and is for the use of the designated recipient. If you are not the intended recipient, you are hereby notified that you have received this communication in error, and that any review, disclosure, dissemination, distribution or copying of its contents is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589�720 of your receipt of these items and destroy the communication and any attachments immediately. Further disclosure of this information may violate state and federal restrictions. Confidential information may include the following: 1} Social Security Number(s} 2} MedicaltHealth Information 3} PersonneltDisciplinary Information 4} Bank Account Information 5} Financial Information 6} Credit Card Numbers If any documentation you desire to submit to the City of Dubuque contains any of the items above, this cover sheet must be attached directly to the confidential information. Please indicate below the type of information that is included. I, , hereby certify that the attached documents include the following protected information: Social Security Number(s} Bank Account Information MedicaltHealth Information Financial Information PersonneltDisciplinary Information Credit Card 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 Dubuque as art of this Claim Against the City. 3f27f2018 Signature Date Copyrighted April 2, 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: Progressive I nsurance Co. on behalf of Andy Bartolotta for vehicle damage, Jordan Roberson for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation THE CTTY OF � I.�'UB�J �.T� MEMORANDUM Masterpiece on the Mississippi � � TRACEY STECKLEIN '� PARALEGAL � 9 To: Mayor Roy D. Buol and Members of the City Council DATE: March 28, 2018 � � Re: Claim Against the City of Dubuque by Progressive Insurance Co. on behalf � of Andy Bartolotta , � I� Clairnant Date of Claim Date of Loss Nature of Claim �� Progressive Insurance 03/26/18 01/26/18 Vehicle Damage �, Co. . �+ �;j This is a claim in which daimant alleges that the vehicle owned by its insured, Andy � Bartolotta, was damaged while being driven on January 26, 2018 by Christina Wilson. � Wilson was traveling northbound on White Street and was allegedly struck by a city police , vehicle which was traveling eastbound on E. 9t" and ran a red light. N � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. � cc: Michael C. Van Milligen, City Manager Mark Dalsing, Chief of Police Fic"ard �erlan, �rogr��ive I�suranV� vo. � 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/Ennai� tsteckle@cityofdubuque.org i