Claim by Lynn McCormick/Partners Mutual Insurance 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
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CLAll4� AGAENST THE CIl`Y qF DUBUQUE, 14111/;�►
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This written report constitutes your claim against ttne Cit�r of Dubu�ue, lowa. YQu shauld
cr�mpiet�this form i� futl anc! attach any add"rtional information that supports yc�ur claim.
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The Claim must be �Filed wifih the Ciiy Cl�rk at City Hall, 50 W. '13t" St., �ubuqu�, IA 52001. It �
will then be referred by the City Counc�l to the appropr�at� depar�rnent for ir�vesfigation.
On�e that inv�stiga�ion is completed, a repor� �nd recammendati�an will be submitted to the
City Cou[ncil. Yvu will b� prc�vided with a copy of#hat r+�port and recommendation,
1HE F�NAL. bEGIS1�N C}N Al�� CLAMMS IS MADE Blf THE GITY CQUNCIL. N�? EMPLOYEE O�
TME CiTY U� DUBUC�UE HAS THE AUTHORITY 70 MAKE Af�Y REPR�SENTATIC}N TQ Y4U �
AS Tt3 WHETHER YOUR GLA[M W1LL C?R WIL.L ���BE P'AID.
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1. Nam� af Claimant: � � � � �� �a . 4�� : �i�r�`���. '��������__ , ;,j
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4. �ate of Incident; _ i
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7. DESGRIBE ACC�DENT OR fJCCURREhI�E THAT CAUSED I�IJURY OR ��4MAGE, (Cive �
full deta�ls upor� which you base your claim. lf a City er�ploye� was �nr�r�lv�d, give the �
emp!€�yee's r�ame.} 1
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9. Give name and address of any witnesses: �
10. Dic� po�ice tnvestigate? (#f sa, give names of officers.)
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11. 1Na� anyorte injured'� (If so, give names, �ddr�sses, and extent of injurie��.
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1�. Wa�s any damage done ta property? ([f sa, describe �aroper[y and the extent Qf �
riama�es. Attach est�mates o# damages vr describe b�sis �or ascertaining extent of
dama�e,j .
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13, 1tVhat ather damac�es dc� you claim, if any? . _._ ... :_ , _ . �
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14. Have you been compensated for any park or all of your c)aim by any insurance ,�
company? (Lf so, gi�re name and addre�s �f�nsurar�ce �ampany and amoc�nt paid.) ��
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15. What amount dp you cl�im �'resm tne G�ty af�ubuque? i
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1�. 1N'hy do ya€� cl�im t�e City of Du��� e �s r+��������r�_�' i
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17. Have you made ar�y claim against anyone else fior damag�s as a resutt of this incident? �
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f es, g�ve r�am�ar� � ress.
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18. If fh� answer tv C2ues#�on �17 is �tes, hav� you received any payrnent from tFtat saurce, '�
and 'tf scs, in what� ount� �
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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 on tlze Mississippi
TRACEY STECKLEIN �
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: August 30, 2018
RE: Claim Against the City of Dubuque by Lynn McCormick, subrogated by
Partners Mutual Insurance
Claimant Date of Claim Date of Loss Nature of Claim
Lynn McCormick 08/30/18 07/01/18 Vehicle Damage
Subrogated by
Partners Mutual Insurance
This is a claim in which claimant alleges that a limb from a City tree fell onto claimant's
2009 Subaru Forester.
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
Steve Fehsal, Park Division Manager
Tom Kramer, Urban Forester
Bill Dressler, Penn National Insurance/Partners
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OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
Su�TE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TE�EPHONE (563)583-4113/Ffvc (563)583-1040/EMai� tsteckle@cityofdubuque.org