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Claim by Sherry Saunders Copyrighted July 2, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Sherry Saunders for vehicle damage, Allan Simms for vehicle damage, Donna Stecher for personal injury. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Saunders Claim Supporting Documentation Simms Claim Supporting Documentation Stecher Claim Supporting Documentation ���� � � � � � ! � � � � � CLAIIVI AG�►11�ST THE �1TY QF DU�IJQUE, IaV11A � ����� ���� � ; 1"his v+rrrwtten repnr� �c���tit�ates y�ur +�1aim ag�ir��t th� City of I�u�uque, Ic�wa. Y�u shc�uld ! �o�plete�his #�rrm ir� fu�( and at��ch �ny additional ir�formatior� fihat supports your claim. Th� �I�im rr�ust �� fiil�d with ti�� Ci#y �I�rk at��ty H�It, 50 W. 13t" St., Dubuque, IA 520t?�i. It wi11 �he� b� r�fe�red by the ��ty �+��r��il fia the appropriate deparEm�nt fc�r inve�tigation. {�r�ce t1�at inv��tig�#ic�n �� �ompl�#��l, a r��t�rfi�nd re�vmm�nda#ion wil! k�e submatted to the Ci�r G�uncil. Yc�� wi11 be� prc�vided wit� � copy c�f th�t r�part an�l rectammendation. THE �1NAL DEGiSI�N (7N AL�L C�AIM� 1S MAC�E BY fiHE �1TY�t}ll�G(L. NO EMPLCJYEE C7F `�H1� C1TY UF a�1�UQU�' HAS °TH� AI�THC}RITY Tt� IV1AF�� ANY REPRESENTATIC}N TO YC)�l A�� 7'CC� 111f��"�I-11�F�`�P`C311� ��,�l�Ui 'V1,11�»�,,, �F�'�VVI�..�. N+(�°�" �I� F�,Al�7a 't. N�me c�f Glai�nant; �P�t"�' -��°� �C.2�.�����-� 2. ��d�-es�; �� /� ���`C�2r"1 t�V�, . i �ifiy: 1 �-�au��/�, state:i a�� �ip: ��t��� � 3. T�lephon� �iumb�r: ��0 � ' ��' �' - .���l,v ; i 4. �ate of ir�cider��; ��r�d � t� ; � �. �"irr�� +a� In�id�r��� '7;¢� CLr» � � � 6. Lc��afiinn o�[n�ider�t{�� �p�ci�i�}: �j utd�r� �. � ��'l�+�5 S �-� � � � � 'T. aE�CR1B� ACGID�IU7' tJR t3CCU1�RENCE TMA�" CAUS�D IN,�U�iY OR C3AIVIAG�. (Give � f�l1 d���i1� upoe� w�i+�� �c�e� b�s� your cl�im. If a �ity employee was involved, give the � �tr�ploye�'s r��nneA� ���- ����,�d t�� ! ,� ���� 9 �G �' c�� �r�����1t e� �� ,���� C}� t'�'� ��riG�G. �G ,' t�,t�S �a r1�'.e,Q� � 8, V1!'hat wer� w�ath�r c€�nditic�ns like? ��- �:� �-�.,�;�� � �v�cs�r ��ei�..�,, � � �. �iae nam� and address of any witnesses. � 10. [3id polic� ir�ve����at�? �If sa, �i�re t�ames a�of�i�ers,j � �t��,� �,fi� 5� � 11, 'Vt1as �nyc�ne injured? (Ifi�a, give r�ames, �ddr�s��s, ar�ci extent �f �njuries). � J�d`c� �r�C: t i"} t�r��.C� � . _ . _ . . _ � � � � f � � � � � � 12, Was any damag+� dc�ne to property? �If soa descrik�e property �nd th�e e�ctent of # darr�ages. Atfia�h ��timat�s c�f damag�s s�r describe basas for ascertaining ext�nt of � d�mag+�,) ' 3 �(�i+94'c G� � (1� �ir(3 Y'k-#^ �t.L N't. �t/ C} i^^ /�i ��!2„ � F '!3. Vlfhat other c�amages c#c� yau c�airn, �f any? n/or�� 14. Hav� �rou b��n �ornper�s�t�d fcar any part car a!1 vf your �1aim by ar�y insuranc� compan�r? (If sc�, �iv� n�m� an�! address c�f insuranc� cc�mpany and am�un� paic�.} t1!c°� 1�, 1�t�at a�cau�� �� y�� �l�i� frc��m fi#�� �ity �a#t��abu�u�? ; `J'e„� �� C`�t.. :Y°- �c� �el� �J�e.,On.;c.f�$., . � � t �G. Why dc� yo� cEaim �h� ���y of Dubuque i� respr�nsibi�"? � � �� t�, _ �a�*C�.. �e., ��'Ar- 1 ji °�7. Mave yo�a m�de ��� �laittxtt against anyon� else far da�nages as a res�rt�c�f this in�id�nt? ''! (If yes, give narrrRe and a�ddress,� � �}e� � � 18. Ifi #h�e at�sw�r to Qt��stion 97 �s yes, hav� yau rec�iv�d any paymenfi frorn that sourc�, il at�d if sca, in wha�amc�ur�t"� � � � � �1at�d �t C�ubuqu�, 1c�wa tF�is � day of t�� � , 20�� �' : � _ i .� � �GC.,� (Sigr�ature) ��e�� ' .��"_ ��r�,��r'� {Print Nam�} �3 ;� _ _ _ ,__r- ..�"'� � �..: �._ *eT-� ;� �; � -�= � � � �� � � � � � �� � � � � (Rev, 5/'��� '�' � `� � � � � � a t � � a � � � � j � �t}�'�iC���l'�1�� � This cc�mm�nication and any atta�hm�n�� may cc�r�fiair� i�formafi�on which is corafi�l�nti�t � and priviieg�d by 1aw and is for th� us� of the desic�n�ted recipient. If yc,u are nc�t the ; �n��nd�d r�ci�i�n�, �ou are hereby noti�i�d that.you hav� rec�ived this c�mmunication in � error, and that�ny rev�ew, �lisctc�sure, diss�mina�ion, d�strfbc�fiion or copying of its ce�n#ents ; is prohi[�ited. Ple�se notify Ci�y of Dubuque irr�meclia�eiy by #e{e�hone at (563j-5�9-4't20 �f �c��ar r��eipt of tk�ese iterns and �d�strs�y ic�� corr�mu��ca�ic�n and any �tfiachments ' ��mim��iat�t�r. Fur�her r�a��l�as�are +�� ���s ir����rr�atia� ��y vaotate stafie and federa] restri�ti��n�. Confiidential infar�nati�n may incl�ade fih�f�lic�win�: 1) Scaci�I ��curit� Numb�r(�) Z} ivledicalfK��fth infc�rmation 3� F'ers�nn�l/�isciplin�ry ln�orm�ti�n �) �ar�k Ac�c�u�t lr�form�tian �� �inanci�llnform�ti�n ' 6) ����it ��r� N�m��r� i#any docurn�n�ati�n yc�u d��ire to submit t� th� Cfty �# Dtabuque c�ntains any c�f the items ab�ve � �his caver sh�et must b� ����h�d dir�c�ly to th� c�nfiden�ial inf�rmation �nd �ndicate the type �f � iri�c�rm�tion that is in�lud�d. 4 l ; € �, '`.�`>�.��"^�`� �r• `���,���5 , hereby �ertify thafi the afitach�d documents a ir��lude th� fc�llowin� prQte���d in�orm�tion; � ( �c�cial Security Number(s) �ank Accaunt Informati�an I Medic�ilH�aith Ir�fc�rma�i4n �inancial Information � � �. � P�rsonn�I/Dis�iplinary inforrrtafiion Credit Card Numberts} � r I understand tt�afi fihis infarm�tion may �e aisfri�ui�� ��t��� t�S� :��� or��s�iz�t��� c�r tQ a�ents of the t �ity �or prc�cessing and I i�ereby aufihorize the City ta act �cc4rdingly taking aPl precaut�ons fio � prot��t t�y inf�rm�tic�n from unn�c�ss�ry distributi�n, � � �.,�� � -.��- �� � ����,�t�r� ��t� � � � � , � € � � � � � � Copyrighted July 2, 2018 City of Dubuque Consent Items # 3. ITEM TITLE: Disposition of Suits 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: Rainbo Oil Company for property damage, Sherry Saunders for vehicle damage, Allan Simms for vehicle damage, Donna Stecherfor personal injury, SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation THE CITY OF ' .�►T.�� �.TE � MEMOl� ANDUM Masterpiece on the Mississippz � � �RACEY STECK�LEIN � � PARALEGAL � To: Mayor Roy D. Buol and Members of the City Council I� 1 DATE: June 22, 2018 � a � RE: Claim Against the City of Dubuque by Sherry Saunders � �� Clairnant Date of Claim Date of Loss Nature of Claim ; �1 � � Sherry Saunders � 06/22/18 06/14/18 Vehicle Darnage �� ��, This is a clairn in which claimant alleges that a City of Dubuque Public Works employee !; struck claimant's parked vehicle while backing into a parking space near the intersection i; of Burden and Strauss Streets. i � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa ii Communities Assurance PooL � �� cc: Michael C. Van Milligen, City Manager ;�, John Klosterrv�ann, Public Works Director � Sherry Saunders � I', il � P � h � � � � � � � � � � � 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 Y � i