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Claim by USAA General Indemnity / David Thimmish, Tyler Sytie Copyrighted April 16, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suites SUMMARY: Dorothy Ernzen for personal injury, USAA General Indemnity Company for property damage SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Dorothy Ernzen Claim Supporting Documentation USAA (David Thimmesh Tyler Sytie) Supporting Documentation � �`� ��y . � � CLAIM AC�AINST THE CITY QF DUBUQUE, It}WA � .. ; � This vmritten report cons�i�c��es your claim agains�t the Ci#y of Dubuque, lowa. o� should � complete this form in full �r�d at�a�h any additic�nal infarmation that�upparts yo�r claim. � 9 The C[aim must be filed with tF�� City Clerk at City Hall, �0 W. 13t" St., Dubuque, IA 52001. It � G wi(I th�n be referr�d by the City Council fio the appropriate department far inves�igation. � Once that investigation is ccrmptet�d, a report and recomme�dation will be submitted tc� the �� Ci#y Council. You will be provided with a copy c�f that repark and recornmendatian, � I' THE FINAL �ECISIt7N CJt� AL� CLAIMS IS MADE BY THE CITY C{�UNCIL. Na EMPLC}YEE C}F � THE GITY t}F DUBUC�UE HAS THE AUTHtJRITY TA MAKE ,�►NY REPRE�ENTATItJN TC? YOU � AS TC}WHETHER Y{}UR CL,�11M WI�L QR WILL N{aT BE PAI[}. � Cj 1. N�me t�f Cl�imant, '�-��A General Indemnity Company a1sJo I�avid T�i�mesh,Tyler Sytie � I �, q��rggg; clo C�erkin,Sinclair&Mahfou�,LZP; 530 B�treet, $th Floor,San Diega, CA 92101 z � fi a 3. Teleph�n� �lumber: 619-308-6876 j� � 4. Date of InCident: 12111/2017 n� �' 5. Time of Inciden�: 4:i6 F.M. �� Iowa '' 6. Lt�Catiott of II�Cident {�e speCific): Roosevelt Street and Tustin Lane in Dubuque, I; � � E 7. DE�CRIBE ACCIDENT t�R {aCCURREN�E THAT CAUSEd INJURY OR D�IMAGE. (Give � fulM details up�+on which you base ycrt�r claim, If a City employee v�ras involved, give the �' employee's n�me.) C.�n December 1 l,2017,LTSAA`s insured vehicle w�s parked Qn Roc�sevelt Street in Dubuque,Iowa,when it was , sfiruck on the left side by a City af I)ubuque vehic�e,driven�y Tirnothy Neuhaus,resultin�in praperky amage. � � n 8, What wer�:weafiher condit�c�ns I�ke? Unl{nc�wn. � ; 9. Give name and address af�r�y witnesses: N/A 10. Did police investigate"? {If so� give names c�f officers.} Yes. Officer Dieujuste Wilkens with Dubuque Po�ice Department. 'E'[. Was anyane irtjured? {If so, give n�mes, addresses, and extent of ir�juries�. � No. � � 6 � f � U3�A Confidential � a��,a��.g��s�� ., � � 12. Was an dama e done to ro ert � If so describe ro ert and the extent of Y 9 p p Y• � � p p Y damages. Attach estimates of damages or describe basis for ascertaining extent of damage.) � 2003 Volkswa�en Jetta;Iowa license plate number: BGH909; damage to the left side;please see attached � estimates and photos. r i � 13. What other damages do you claim, if any? None. 14. Have you been compensated for any part or all of your claim by any insurance I company? (If so, give name and address of insurance company and amount paid.) � USAA General Indemnity Company; c/o Clerkin, Sinclair&Mahfouz,LLP; 530 B Street,8th Floor,San Diego, CA 92101 i Amount paid: $2,312.45 ; � 15. What amount do you claim from the City of Dubuque? � $2,812.45 r'' �' � �I 16. Why do you claim the City of Dubuque is responsible? !� TimotherNeuhaus, driving a City of Dubuaue vehicle, struck USAA's insured narked vehicle. t;, i� 17. Have you made any claim against anyone else for damages as a result of this incident? ; (If yes, give name and address.) ' Na I� � 18. If the answer to Question 17 is yes, have you received any payment from that source, t� li and if so, in what amount? �� N Dated at Dubuque, lowa this 2�� day of �G�� , 20 �b . � � k Ashley Feuerman on behalf of USAA �i General Indemnity Company a/s/o L� David Thimmesh,Tyler Sytie (Signature) , Ashley Feuerman � (Print Name) � � ,..�j� � � _ �� ,:,,; : �; �:- - ��, � "..,"w.� �:;`� �� (Rev. 7/12) f u,� �"�:�� ;� e� � � 0 9 01119 c 9 e 116 f 9 4 USAA Canfidential !; � � Confidential This cornmunication 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)-589-4120 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. , i Confidential information may include the following: �i �I 1) Social Security Number(s) � 2) Medical/Health Information � 3) Personnel/Disciplinary Information �� 4) Bank Account Information �j 5) Financial Information � 6) Credit Card Numbers f� �; � 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 and indicate the type of ��; information that is included. � I � I, , hereby certify that the attached documents � include the following protected information: � Social Security Number(s) Bank Account Information � �Medical/Health Information Financial Information t, � PersonneUDisciplinary Information Credit Card Number(s) I � I understand that this information may be distributed within the City organization or to agents ot 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 part of this Claim Against the City Signature Date ,I 0 9�1119 c 9 e Z 16 f 9 4 ��a4 Confidential � � Copyrighted April 16, 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: SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation i THE CTfY OF �.T� E MEMORANDUM Masterpiece an the Missrssippi , TRACEY STECKLEIN � i PARALEGAL � I To: Mayor Roy D. Buol and Members of the City Council DATE: A ril 11 2018 I� p � � � RE: Claim Against the City of Dubuque by USAA General Indemnity Company 'i on behalf of its insured, David Thimmesh, filed by Clerkin, Sinclair & I Mahfouz, LLP, Attorneys at Law �I � Claimant Date of Claim Date of Loss Nature of Claim � '� ',;I USAA General 04/09/18 12/11/17 Vehicle Damage I� Indemnity Company � 3 , This is a claim in which claimant alleges that a vehicle which parked on Roosevelt Street I� near Justin Lane, owned by David Thimmesh, was struck and damaged by a City of �I Dubuque snow plow truck. This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. i � cc: Michael C. Van Milligen, City Manager � John Klostermann, Public Works Director � Cl�rkin9 Sin�Iair� Mahfouz9 �LP, At��rnPy� at L�w � � � OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA � Su�TE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/F,vc (563)583-1040/EMai� tsteckle@cityofdubuque.org s