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Claim by Stanely Wasmund THE CITY OF �►LTB E MEMORANDUM � � Masterpiece on the Mississippi � TRACEY STECKLEIN PARALEGAL � To: Mayor Roy D. Buol and � � � Members of the City Council � � �� DATE: July 24, 2018 ; � RE: Claim Against the City of Dubuque by Stanley M. Wasmund � � , Claimant Date of Claim Date of Loss Nature of Claim � Stanley Wasmund 07/24/18 07/17/18 Vehicle Damage I� 'I This is a claim in which claimant alleges that while his vehicle was parked in his driveway �j at 1899 St. Joseph Street, the vehicle's back window was shattered by a rock which was �� thrown from a lawn mower thafi was being operated by a City employee who was cutting I� the grass next to claimant's yard. � �;� I'I 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 '�� John Klostermann, Public Works Director �j Kimberly Erickson � � ,a I OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA ` SUITE 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 I Copyrighted August 6, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Teresa Davis for vehicle damage; Giese Sheet Metal Co., Inc., for property damage; Justin Smith for property damage; True Fitness/Life for property damage; Stanley Wasmund for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Davis Claim Supporting Documentation Giese Sheet Metal Claim Supporting Documentation Smith Claim Supporting Documentation True Fitness/ David Claim Supporting Documentation Wasmund Claim Supporting Documentation ��1 h��.0 +�''� CLAIM AGAINST THE CITY OF DUBUQl1E, IOWA V"�o�c`c-c�. �. �I z.LS-�c��-, This written report constitutes your claim against the City of Dubuque, lowa. You should complete this form in full and attach any additional information that supporfis 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. On�e that in�re�tigation i� complet�cl, a r�port and recorr�rr�er�da#ion �ill be �ubrinitted 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 THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT B PAID. � , i =-: � 1. Name of Claimant: . �""�, � � � , I , I 2. Address: � � : i • � I City: State: -L� ��, Zip• � I W y � 3. Telephone Number: "" �� 4. Date of Incident: � � q 5. Time of Incident: � �"`�� . �,,�-,�'� � 6. Location of Incident (Be specific): � � � d�,, , '� � 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT 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.) � l � �'�°� � �-� � � r"� G� F �� 8. What were weather conditions like? ��2i'�,-�a �- �/ ' 9. Give name and address of any witnesses: t�� - 10. Did police investigate? (If so, give names of officers.) "7 C � . - �.�� '�� `� °-�'�� y` ' � � F � � ' �� - �� C� - � � ��' 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). ��-��1�-�`� �� 12. Was any damage done to property? (If so, describe property and the extent of ' damages. Attach estimates of damages or describe basis for ascertaining extent of ', damage.) I �� I 13. What other damages do you claim, if any? ��i��' , � , 14. Have you been compensated for any part or all of your claim by any insurance ; company? (If so, give nam� and address of insurance company and amount paid.) ; � 'I _ i ; 15. IM at amogggu�� nt do you claim from the City of Dubuque? �I` �E I 16. Why do you ciaira� the City of Dubuque is responsible? � ` , � " � � �� ,i ' � .�"' ��t.� ; � , �,, a� i � �m. � ��`'S'��'9 ,i ��u. � ��'. �.`�' �r,�t�:r� �:� ��`�.�? ��'� t'�5 � .� ,�' � , �,.; �- � 1 . ave you made any clatm against anyone else for amages as a result of thes incident? I (If yes, give name and address.) .�,�� ;� 18. If the answer to Question 17 is yes, have you received any payment from that source, '�i and if so, in what arnount? Dated at Dubuque, iowa this;��day of � , 20 �e�' . '� (Signature) . . ~..j �.nii . �: � ,.'^".. . ' . . . . =� .�„ .. � � 4...a (Print Name) ;�-_C.�..� � �; �� . ; �a �` !�q f` ;`�5 4�;� � � � � �� i �, (Rev. 5/18) Confidential 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)-589-4120 of ��ss� ��9,�¢ �� ;�vrr, ur�� d��troy #h� �v��unicati�� a�� a�y at�avr��d� immediately. Further disclosure of this information may violate state and federal restrictions. . Confidential information may include the following: 1) Social Security Number(s) 2) Medical/Health Information 3) Personnel/Disciplinary 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. �� ' , hereby certify that the attached documents include the fol wing protected information: Social Security Number(s) Bank Account Information MedicaUHealth Information Financial Information Personnel/Disciplinary Information Credit Card Number(s) I 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 distribufion. ..--�-.. �-�� ~. � � Signature Date � � f i � . i � , ; � '� � � 3 Copyrighted August 6, 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: Teresa Rainbo Oil Company for property damage; True Fitness/Life for property damage; Stanley Wasmund for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo