Claim by Melvin Moss 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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.ri��en repnrt constitutes yaur claim against the Ci�y of Dubuque, lowa. You s ou1c1
�rnplete this form in ful( and attach any additional informatian that suppQrts your claim.
The Claim must be filed with tl�e City Clerk at City Hall, 50 W. 13tn S#., Dubuque, IA 52001. It
wilt then be referred by the City Counci! to th� approp�iate d�par�tmenfi fQr investigatior�.
Once that inves�igatior� is completed, a repor� and recommenda�ion will be submitted ta the
Cify �ounci[. Yau will be pr+�vic�ed with a cc►py of�hat r�pe�rt ar�d recomm+�ndafiion.
TNE F'INAC. DECISICIN QN ALL CLAIMS IS MADE BY TNE CtTY COUNCI�. NO EMPLC�YEE QF
THE CiTY OF DUBUQUE HAS THE AUTHORITY T{� MAKE ANY REPRESENTATIC�N TC? Yt}U
AS TO WHETMER YOUR CLAIM WILL OR 1NILL NOT BE P�11D.
�1. Name af Cia�mant: �.j��,�.,�; � ,�`
�. Address: �,� ,� � �� J�r�� �'':�.�'" �,�"' °� p l;
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��ty: ..�a� <'�- .._..�..� .._, �ta�te: � Zip:
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3. ?epephone Number: �_� � � `�� �"/`-�.,�,�� �
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4. Date af Incident: ���. �-��"�r�
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5. Time �af lnciclent: ��,,,������ ��� �� ��t� �
6. Lo�ation c�f lrtcident (Be specific): �� �: � ?�` ,� ;i
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7. DESCRIF3E A�GID�N�' CIR C?CCURRENCE T�-IAT CRLlSED i1NJURY OR DAMAGE. {Ciive ��
fuxl details upon which you base yc�ur claim. If a City employee w�s �nvalved, give the� �
er�ployee's name.� �
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8. VUhat were weather cond�t�e�ns I�ke . �,-
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�. Cive name and adciress c�€any witn�sses: �.' ;,�� ��a��G� ������� �-�1 �
�.�Jv�;� ���s � �l� �'��r �t%�� �a�- �
10. Did police investigate? (lf so, gi�re names of offic+�rs.) �
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1'�. Was �nyone injured? (lf so, give names, addresses, and extent of injuries}. � �
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�12. Was any damage dane ta prc�per�y? {If so, describe property and tl�e extent af '�
damages. Att�ch es#imafies of d�mages or describe basrs for ascerEaining extent of �,
damage.)
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r '13. Wha� other damages do you claim, if any? �
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'14. H�ve ou beer� corra ensa�ed for an �r� or �I! c�f our claim b an �
Y � Y � Y Y Y insuranc� �
cr�m�aar�y? {If so, gi��e name a�nd �dc9r��� �f insur�t��� cem}�an�r �nd art�c��ant paid,} �
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'15. Whafi amour�� da you cl��� frc�m tl�e Ci y of�ubuq��`� '�
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16. WF�y da yc�u cl�im fih� City of�ubuc��e is res�onsible?
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17. H�v� �ou made any claim agair�st anyar�� els� fior d�rt��g�s a� a result of this ir�cider�t? �
�If�res, give�ra�me a�d address.) �
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1�. If th� answer to Questian '17 is yes, �have yau receiv�d an�y payment from that source, ;
and ifi so, in what amount? �
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Dat�d at Dubuque, Iowa this _� d�y of �'�� , 20�, ��
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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
Mnsterpiece on tl�e Mississippi
TRACEY STECKLEIN )—
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: August 27, 2018 I
RE: Claim Against the City of Dubuque by Melvin Moss
Claimant Date of Claim Date of Loss Nature of Claim
Melvin Moss 08/23/18 07/24/18 Vehicle Damage
This is a claim in which claimant alleges that a city tree fell onto claimant's vehicle at 2725
Ventura Drive and broke the back window of the vehicle.
This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa I
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Steve Fehsal, Park Division Manager
Tom Kramer, Urban Forester
Melvin Moss
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
Su�TE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563)583-4113/FAx (563)583-1040/Enn,ai� tsteckle@cityofdubuque.org