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Claim by Jane Walsh Copyrighted July 16, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Kimberly Erickson for vehicle damage, Robert Johnsen for vehicle damage, Anthony King for vehicle damage, Justin Mills for vehicle damage, Jane Marie Walsh for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Erickson Claim Supporting Documentation Johnsen Claim Supporting Documentation King Claim Supporting Documentation Mills Claim Supporting Documentation Walsh Claim Supporting Documentation ��\ �� M CLAIM AGAINST THE CITY OF DUBUQUE, IOWA �� Sz� �J . J�-�S�� This written report constitufies your claim against the City of Dubuque, lowa. You should complete this form in full and attach any additional information that supports your claim. The Claim must be filed with the City Clerk at City Hall, 50 W. 13t" St., Dubuque, IA 52001, It will then be referred by the City Council to the appropriate department for investigation. Once that investigation is completed, a report and recommendation w.ill be submitted to the City Council. You will be provided with a copy of that report and recommendation. THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF TFiE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. 1. Name of Claimant: � � ,j (,�'d' 2. Address: � � Wl� .� 9 ) � � • City: � r State: Zi �,� � p• 3. Telephone Number: / � �� -�� ' , 4. Date of Incident: � II . � /f, F� � d 5. Time of Incident: / 9 Cl �S� � �� ,� �� 6. Location of Incident{Be specific): e � � �J / a � �� i 7. DESCRIBE ACCIDENT OR OCCURRENCE THA�' CAUSED INJURY OR DAMAGE. (Give i full details upon which you base your claim. If a City employee was involved, give the � employee's name.) �`1 ��J�'�' �� ` C� _ � S�" �i � o , r � 8. What were weather conditions like? ��V i 9. Give name and address of any witnesses 10. Did police investigate? (If so, give names of officers.) f � /�i" .� ' 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � � ; u � i i � I 12. Was any damage done to property? (If so, describe property and the extent of I damages. Attach estimates of damages or describe basis for ascertaining extent of damage.) � �U� C f��° � S q`�/'� �', 13. What other damages do you claim, if any? � ��''�°-� 14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give name and address of insurance company and amount paid.) � � fl y } y �uqUe? 15. W t amou � do ou claim from e Cit of D b � � ��i` 16. Why do you claim the Cit of Dubuque is esponsible? ; �E. ..Q df:� �"� � J� . _ �� 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address) : � f�� 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in whaf amount? : Dated at Dubuque, lowa this� day of � �l(,� , 20� o ��" ' ignature) � �'}�J �,/ / �� . -�' "/• l�l.�' � r �� (Print Name) ,�t«� � �; : ��. �� . � c� � ��s }"'} M1 . . .-L...! ,,,.'k { 3 F 4 m. � �-�..A �� ,.,,"�� --�^"� �� f�l� � �c�1�- ��3� � ,� ��f � � � (Rev. 5/18) r� °^�' � '� �a t �I I I � I Confidential i 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 I, error, and that any review, disclosure, dissemination, distribution or copying of its contents �I is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of �o�r r��p+ �f #t�� #�rn� �r�J ��#roy� #hc �v^i'i1e`'i7i.�iii�afiDi'i a�u a�� a�tav��i�. , immediately. Further disclosure of this information may violate state and federal ! restrictions. � ' Confidential information may include the following: 1) Social Security Number(s) 2) MedicaUHealth Information 3) P�rsGnr�eUDisciplinary 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 and indicate the type of information that is included. 4 �, ��'� ��'�, f � �� , hereby certify that the attached documents include the following protected information: Social Security Number(s) Bank Account Information Medical/Health Information Financial Information Personnel/Disciplinary Information Credit Card Number(s) I understand that this information may be distributed within the City organizatian or to agents of the City for processing and I hereby authorize the City to act accordingly taking all precautinns to protect my information from unnecessary distribution. � , Sign ture Date c�� - �� • ��P� �---�� ..� � � � THE CITY QF ,v.,. .C�UB E MEMORANDUM Masterpiece on the Mississippi � 4 � TRACEY STECKLEIN � � PARALEGAL � � To: Mayor Roy D. Buol and � �: Members of the City Council � � DATE: July 11, 2018 '� ;� RE: Claim Against the City of Dubuque by Jane Walsh �'� i, Claimant Date of Claim Date of Loss Nature of Claim � i I Jane Walsh 07/10/18 07/04/18 Property Damage � This is a claim in which claimant alleges that during a police foot pursuit, a suspect ! attempted to jump claimant's privacy fence and damaged the fence. ' p �� 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 ;; Mark Dalsing, Chief of Police �; Jane Walsh � , � u � � � � � � � �g 1 � � OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA � SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 � TE�EPHONE (563)583-4113/Fa,x (563)583-1040/EMai� tsteckle@cityofdubuque.org � � V Copyrighted July 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: Kimberly Erickson for vehicle damage, Robert Johnsen for vehicle damage, Anthony King for vehicle damage, Justin Mills for vehicle damage, Jane Marie Walsh for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo