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Claim by Hertz Rent-a-Car Copyrighted September 4, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: William Baum for vehicle damage; Hertz Rent-a-Car for vehicle damage; Adam Jordan for vehicle damage; Lynn McCormick/Partners Mutual Insurance for vehicle damage; Melvin Moss for vehicle damage; Jeremy Noel for property damage; Marilyn Thoma for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Claim by William Baum Supporting Documentation Claim by Hertz Rent-a-Car Supporting Documentation Claim By Adam Jordan Supporting Documentation Claim by Lynn McCormick/ Partners Mutual Insurance Supporting Documentation Claim by Melvin Moss Supporting Documentation Claim by Jeremy Noel Supporting Documentation Claim by Marilyn Thoma Supporting Documentation � CLAIM AGAfN�T THE +�lTY t7►� DUBU UE 1C�WA � ��- c� , �� ; .�, ; Thi� writ#�r� re�+art cons�itutes �rs�ur ct�irry against the ��t� of Dul�uque, lowa. You should � compl�te thi�fc�rm in ftall and attach a�ny additional informatior�tha�t su�po�s yv�cr claim. � n � Th+� Claim must be fife�l with �he C�#�Cl�r�a�t Ci�ly Hall, �t�W. 9��'�t., C7ubuque, ld�l 520tl�1. Ifi � will �hen b� ref�rred b� the City Cac�nci� to the �pprapriate de�artment for inve�ti�atio�. � t3nce�h�t investig�tion is c+�mpl�t�d, a r�p�►rt and r�cc�mme�dation wi11 be�u�amitt�d to th� � Gity Cour�cil. You wi11 be prc�vided with � copy of t�at report�nd recomrnendatiQn. � � TH� FINA�.l�E�[�IDN C�N r4L�C�All4�� IS MAD� BY THE �1TY GCiUNCIL.. IVfJ �9UiP�tJYEE C}�' � THE CI'1`Y'U� �UBUt�ti� HAS T'HE AUTH(3R�TY T� 1lPIa4K� ANY R�PRESENT�RlT1UN T4 YC1U � AS TC}WHETHEI�YC�#�R CLAiM 1NILL t�Ft VV1L�I�C'�T �E P'A1�3. � ; � 1. Nara��af Glairnant: +��rrx��t a c�� !. Add�e��: �a��.�� fi � �ity; ��x��d ��ate: F� Zip: s�7�a ; i � �. Te#eph�►n� h��r�ber: ��s��-�t�t� k � a �. C�a#�of in�ide�t: a.��sl�� 5. '�'�me�f 1n�id+�rat: ��.�� A La�c�kior� trf ln�ident��spe+�ifi�}: 924I0 GE_�N CIAK ST.�UEil1,��JE IA � p Ir � 7. �}�"�St:R.1�E /��C:ECfEN't' C1� t��:t:U12�tENGE THJ4T #�'+J�4.USiED I�I.�P[�R'Y` �1�`. [�/��lplCaEo �C`a!9►@ � full d��ails upa�n v�rhich yc�cr bas� yaur �ta�m. If a City +�m�ploy�e v+ra� irtvolv�d, giv� th� � �rnploy��'r na��ne.) � ; J � r � J �� uv c��r��e�a�K. 8. �'Ithat wr�r��rreath�r��nditican� �i�Ce? ��a 9. Give name and addres� �«f any wi�r��s�es: �� 10, Did police investigate? {[f so, �irr+� narne� of affi�e�s.) � DUBUQll�PC?,C}F�IGEEd HAFtL}EtdLIEN BA(.��E#�CASE#2�"i8-t}03398 °11. W��anyar�e injur�d? {��so, giv� names, acidress�s, ant� ext+�nt af irtjc�ries}. r�c� j � � 12. Was any damage done to property? (If so, describe property and the extent of � damages. Attach estimates of d�mages or describe basis for ascertaining extent of � damage.) ;� �� j� SIDE REAR BUMPER,QUARTER PANEL AND TAIL L.IGHT. I�� ;I ':l 13. What other damages do you claim, if any? ��A i � �, �II 14. Have you been compensated for any part or al! of yaur claim by any insurance ,�± company? (If so, �ive name and address of insurance company and amount paid.) il� N/A � � i 15. What arnount do y4u claim from the City of D�buque2 i $1559.86 '' p� �,i 16. Why do yau claim the City of L7u�auqt�e is responsibie? '� �� IT WAS YOUR EMPLt�YEE WHO HIT QUR RENTAL VEHICLE �� 17'. Flave you made any clairro against anyoree else fcar dam�ges as a result of this in�ident? ; (If yes, give name ao�d address.� '; �� '� i 18. If the answer to Question 17 rs yes, have yea� receiwed any payment �Erom that source, �, and if so, in what amount? �� I �I I! Dated �t Dubuque, lowa this 22 day of AUGusr i '2(� 18 . la �,,�'`� .e.__.�.W�__..___�._....___._..._..._e_._.�_ �� ..a_il �.M ''� � . __. (Sigrtattare) RAMQNA VASQUEZ (Print Name) g _� t:�::a �:_=�� .:.�::: � �.:� �,_., (Rev. 5/18) ::� (-�' �.� �; .�� f�_ g---�-, �— ._.....: _.� cn ` +LL� � � �� ca �'�� Copyrighted September 4, 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: Melvin Moss for vehicle damage. Hertz Rent-a-Car for vehicle damage; Adam Jordan for vehicle damage; Lynn McCormick/Partners Mutual Insurance for vehicle damage; Melvin Moss for vehicle damage; Jeremy Noel for property damage; and Marilyn Thoma for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo THE CITY OF DUB E MEMORANDUM Masterpiece ori t6ie Mississippi TRACEY STECKLEIN � PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: August 29, 2018 RE: Claim Against the City of Dubuque by Hertz Rent A Car Claimant Date of Claim Date of Loss Nature of Claim Hertz Rent A Car 08/27/18 04/26/18 Vehicle Damage This is a claim in which claimant alleges that a Transportation Services employee struck claimant's parked vehicle near 1200 Glen Oak Street. 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 Ramona Vasquez, Hertz Rent A Car OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW I�LACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHotvE (563)583-4113/F,vc (563) 583-1040/ ENta,i� tsteckle@cityofdubuque.org