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Claim by Channing Ellison 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 ►_�- �,,1 ' �� CLAIM AGAINST THE CITY OF DUBUQUE, IOWA �'��'� �. s-��i�.� ' This written report constitutes your claim agains# the City of Dubuque, lowa. You should � complete this form in full and attach any additional information that supportsyour claim. !I � 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 will be submitted to the �.I 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. N4 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. �; �, �I 1. Name of Claimant: (�,�1 � �� C�� li � _ `� �{ 2. Address: �� . �- � �. � � ;�; , ,. �s � _ . �; City: � � �.. State: �-- .�. Zip• � '' �� 'f � � � � � �' � �`- i � 3. i eiepinone �iumber: �a 1 .� .� ..�� ` � a� , i 4. Date of Incident: � �� 5. Time of Incident: �� . � 6. Location of Incident (Be specific): � �-`� � �, _ � , � ; �� i, 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 �{ em��y��'� �;��.� t � � ��V� �� 8. What were weather conditions like? _ �`�--�� C� � g 9. Give name and address of any witnesses: �� 1 �`' � q i 10. Did police investigate? (If so, give names of officers.) � 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.) � � � � � � l � `� � � ,� " . i;.� 1 '� 13. What other damages do you claim, if any? � � �� ;, i �i 14. Have you been compensated for any part or all of your claim by any insurance � � company? (If so, give n�me and address of instarance company and �m�unt paid.) 'I � � 1 h _ I, : : 4 ��. �n!ha# ��o!,a!�t �� ;�� L?�r� ft'�:�? #hQ C:#y rf Q�4��aque? � � �` i � L � � � �,`T� �. �a � � 16. Wh do ou claim the Cit of Dubu ue is res onsible? � � � �� Y Y Y q p ,; � � � � � l � 17. Have you made any cla6m agains� anyone else for darmages as a result of this incident? I�" (If yes, give name and address.) � � � 18. If the answer to Question 17 is yes, have you received any payrnent from #hat source, � and if so, in what amount? �� f Y Dated at Dubuque, lowa this day of , 20 � � ��` � "'---- (Signature) --�- � F�� :� �� r,,�°� ! �� (�+ �. ►�, r� ►� �, , r� �-1 � i�� -'� (Print Name) - .�.� �, �, �: =� �:� r--�; � � �� . . . . � XI"� !^q y�e4 �..�g L.�^!y F..y , - . t lA �"'-') �� (ReV. 5/18) � i Confidential .„rs 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 your receipt of these items and destroy the communication and any attachments 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 i 3) Personnel/Disciplinary Information � 4) Bank Account Information ' 5) Financial Information 6) Cre�it ��►-�1 N�!mbp�-� �. !i If any documentation you desire to submit to the City of Dubuque contains any of the items above li this cover sheet must be attached directly to the confidential information and indicate the type of I; information that is included. �i ;! �, �� , �9 I, �" �� l f? � t��S C�'.e � , hereb certif th � y y at the attached documents a include the following prot cted information: � Ij Social Security Number(s) Bank Account Information � � � ",�eu:cGl/H�alth �r�f�r�►�diic�►� rinancial Information � �� !I Personnel/Disciplinary Information Credit Card Number(s) � , 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 distribution. � Signature � �� 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 THE CITY OF DUB E MEMORANDUM Masterpiece on tl�e Mississippi TRACEY STECKLEIN � PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DaTE: August 16, 2018 RE: Claim Against the City of Dubuque by Channing Ellison Claimant Date of Claim Date of Loss Nature of Claim Channing Ellison 08/16/18 08/10/18 Vehicle Damage This is a claim in which claimant alleges that a City of Dubuque parking meter attendant scratched the side of claimant's vehicle. 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 Russ Stecklein, Field Operations Supervisor Channing Ellison OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SuirE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563)583-4113/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org