Claim by Daniel and Christina True 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
����-2c.
L��sud� S�rU� c�s
CLAIM AGAIfVST THE C17Y OF DUBUQUE, IOWA �nc��n�.�r�,��
��tiru.�r ��,�,-f-:
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. 13th St., Dubuque, IA 52001. It
will then be referred by the City Council to the appropriate department for investigation.
Once that investiga#ion is completed, a report and recommendation will be submitted to the
City Council. You will be provided wiith 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 BE PAID.
1. Name of Claimant: �(�+�� \ ��.r`fi�'{''�v1�� T�'l.�.sZ_
2. Address: a� 5y � ��1,�( J`C�.
City:�'j�� State: �If� Zip: ��;�CY�)
3. Telephone Number: �I����'l�1�' �3�
4. Date of Incident: _ ����� " I�
5. Time of Incident: �1 u� � '� ��,
6. Location of Incident (Be specific): ����T � ��.1 ���, �i,�ji.�.�ii�_ ��
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
ful! details upon which you base your claim. If a City employee was involved, give the
employee's name.)
� ,
_ (�1 N1��V14.�G�,�l�V�- �>>C� �f� 1 Jl���U'1� D� �U��l� .�Vl(�✓t-F� tT`�s�
, �
� '1�L� �. � �� 1 r :'`� C�l.(.11 � ► V
8. What were weather conditions like? 0�
9. Give name and address of any witnesses: � � �-1 '` � + S�'-
��(a�-�10�3-�3 � 7�:��i..v2. ;f_�
10. Did police investigate? (If so, give names of officers.)
��
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
�U �
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 F�S � rn I�A� �'���� ���J�C=� ��✓�
13. What other damages do you claim, if any? NI�
14. Have you been compensated for any part or all of your claim by any insurance
i;ui'i'i ai���% �ii�G iV� iia�iii� ali� 8tau��cSS fii ii�S'Ji��Yi�e c'.vrii a�i a7iu ai��aUi�i ai�.°
� y t , � ���y T p� �
���,d
15. What amount do you claim from the City of Dubuque?
� ��5� 5 'l ,"t� �
16. Why do you claim the City of Dubuque i responsible?
�, - c�c�� '� � ' ��,c� �bre�- � � �c�,,�.
c,�-�1 � � ���,��d �� ����,+� ����f � �,�.�;�,.
17. Ff'ave you made any claim against anyone else for damages as a result of this incident?
(If yes, ive name and address.)
��
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, lowa this 3r� day of , 20�.
;� � "d�� ^ (Signature)
�p��� 1 �11- l'r�� �-4Zr�s-t�;�� � l,r�.-� (Print Name) �
�' C -�-�
�' G7 R'-,
' CL' 1 �
W � :
-.' ,. f j i
- �r � �
y �
_ �� (��
(Rev. 5/18) � �"' `•° �
/J
<.I) C�
��
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
'I'HE CITY OF
�� � MEMO �ZANDUM
�
Masterpiece on the Mississi�pi
i
�
�� � �
TRACEY STECKLEIN
PARALEGAL I
�
��
�i
,
To: Mayor Roy D. Buol and i'
IVlembers of the City Council �
�,
�i
DAl°E: August 6, 2018 If
I
RE: Claim Against the City of Dubuque by Daniel & Christina True j�
��
Claimant Date of Clairn Date of Loss Nature of Claoa�n � �
,;
Daniel & Christina True 08/03/18 07/25/18 Property Damage j'
��This is a claim in which claimant alleges that a City of Dubuque pavement milling machine �
struck a tree in front of 2954 Elm Street breaking the water service line. �
7
�
This claim has been refierred to Public Entity Risk Services of lowa, the agent for the lowa �
Communities Assurance PooL
�
cc: Michael C. Van MilBigen, City Manager
John Klostermann, Public Works Director �
Daniel & Christina True �
y
�
�,
�
�
�
�
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/EMai� tsteckle@cityofdubuque.org
I