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Claim by Robert Duster Copyrighted August 20, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Thomas Coyle for vehicle damage; Robert Duster for property damage; Channing Ellison for vehicle damage; Robert Johnsen/Nationwide for vehicle damage; TFM, Co. for property damage; Daniel and Christina True for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Coyle Claim Supporting Documentation Duster Claim Supporting Documentation Ellison Claim Supporting Documentation Johnsen Claim (additional submission) Supporting Documentation TFM, Co. Claim Supporting Documentation True Claim Supporting Documentation , �� CLAlM AGAINST THE CITY OF DUBUQUE, IOWA � 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 supports your claim. The Claim must be filed with the City Clerk at City Hall, 50 W. '13t" St., Dubuque, IA 52001. It I, will then be referred by the City Council to the appropriate department for investigation. � Once that investigation is completed, a report and recommendation will be submitted to the ' City Council. You will be provided with a copy of fihat 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 BE'PAID. j � � 1: Name of Claimant: ��:� ��^� �� r��-��" a 1 { 2. Address: � � �.� �-"�' ;� L,� � �.l� �� , � ` . � City: ��t1 � ,� State:.�.-C�G.�� Zip: � �� I ` � 3. T�lephone Number:,. ��, � ��- � Q '�� 1 ,� 4. Date of Incident: '�� : 'i � � � � � 5. Time of Incident: f�, r �� !� �(, _ : , � 6. Location of Incident (Be specific): �� 0.� �� _�a�� .��y �,,� � �,��- 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. If a City employee was involved, give the employee's name.) ��1 �� G�� l� � G" ,-�'� Ily , f � � 8. What were weather conditions like? ��' 9. Give name and address. of any witnesses: �C�6J � 10. Did police investigate? (If so, give names of officers.) f`9� 11. Was anyone injured? (if so, give names, addresses, and extent of injuries). �� 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.) o � ' , a � �-��- � � �:� � � �� ► f� �-�� ,�� . . � �'� �� .��: �� ;�� ,�� .� 13. What other damages do you claim; if any? 1U�� ` � �� ^+ j � �61� ''JJ'' P ' �Y . ��v`d..I 1{1 � � � s_. � - � � � 14. Have you been compensated for any part or all of your claim by any insurance � c�ampany? (If so, give n�me and address of insurance campany and am�unt paid.) � �� What amount do you claim from the City of Dubuque. �; `� I �(�� C? r i 16. Why do u claim the City of b que is esponsible? : � .�'" ��.� �� E � � 17. Flave you made any claim against anyone else for damages as a result of this inciden#? (If yes, give name and address.) - ��.8� � 18. If the answer to Question 17 is yes, have you received any payrnent from that source, � and if so, in what amount? : � �.1�la.�� d .,�,L Dated at Dubuque, lowa this _� day of ��i,r��d , 20 f�. (Signature) :� �AM �.,. �:�`�-� �� :�� , �.�" (Print Name) _=� C-' �� ` _ �� .,� � � ' �� ;�:� �� ,�, .�� .�, �..+ �,f .. ��, � c.e:� (ReV. 5/18) f � i �U17�IC�G't1�lc'�� This communicafiian anci an}� a#tachmer�ts may contain information which is cQnfid�ntial � and privileged by ��aw and is for the use of the desic�nated recipient. lf you ar� not #he ir�t�raded recipient, you are hereby no�ifi�d that yoc� have received this communicatior� in � error, and that a�ay review, disclosure, dissemination, t�lStl"1�3U�IOC1 t�1' C0�7�t1I1C� O'� 1tS COi��l'�S � is prohibified. Plea�e notify City of Dubuq�ze immediately by telephone at �563)-�89-4120 of " your receipt of thes� ifierr�s ar�d destroy th� corrim�anication anal any attachments � immediate[y. Furfiher dise�osur� af' this infc�rmafic�n may violate state and federal � � res#rictiQns. • � � Confidential inf�rmati�n may includ� th� fflllowing: � � � � �; 1} Sacial Security N�amber(s} � 2) MedicallHe�lth Informatior� � 3} Persc�nnellDisciplirrary Informati�n 4} B�nk Account Infarmafiior� y 5) Financiallnfc�rmation i 6� Credit Card Numbers � ; If any �t�cumentation yc�u desire tc� s�bmit t� the City of Dubuque cantains any t�f the items abc�ue j fihis caver sheet must be afifiached directly tc� the cc�nfide�tial informafiion and indic�te the type of ir�form�tion that is included. � , ;i � � � E, , hereby certify that th� attach�d documents include the following protected information: Sc�cial Sec�rity Number{s) Bank Accaunt Informatian !� � MedicallHealth Informatian Fir�ancia[ Irtformation PersonnellDisciplinary Infc�rmation Credit Card Number{s) � � I understand that this information rn�y be distributed wi�hin the City organizatic�n`or tc� ag�nts of the Cifiy for prc�cessir�g and I hereby authorize the City to act accordingly taking all precautic�t�s to protect my ir�fc�rmati�n from unnecessary distribution, � y �� - � � ignature Date � , � � , � Copyrighted August 20, 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: Thomas Coyle for vehicle damage, Channing Ellison for vehicle damage; TFM Co. for property damage, Daniel and Christina True for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo rr�e ciry oF DUB E MEMORANDUM Mnsterpiece an Uie Mississippi TRACEY STECKLEIN � PARALEGAL To: Mayor Roy D. Buol and Members of the City Council Dnie: August8, 2018 Re: Claim Against the City of Dubuque by Robert Duster Claimant Date of Claim Date of Loss Nature of Claim Robert Duster 08/07/18 07/25/1S Property Damage � This is a claim in which claimant alleges that a water fountain was damaged in claimanYs home when a firefighter was trying to maneuver an ambulance cot in the dark. This claim has been referred to Public Entity Risk Services of bwa, the agent for the lowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager Rick Steines, Fire Chief Robert Duster OFFICE OFTHE QTV ATTORNEY DUBUQUE, IOWA SuiTe 330, HARBOR View Puce, 300 MaiN STrzeer DueuQue, IA 52001-6944 Te�ePrioNe (563)583-4113/Fta (563)583-1040/Ema� tsteckle@cityofdubuque.org