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Claim by Kelsey Caspersen Copyrighted September 17, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Kelly Casperson for vehicle damage, Jerald Kinsella for property damage, Gerald Klein for property damage, Abby McGrane-Ralston for vehicle damage, David Prince for vehicle damage, Steve Ruden for property damage, Daniel Scott for property damage, Sisters of the Presentation for property damage, Brock Tyner for vehicle damage, Morgan Weaver for vehicle damage, Doug Winner for vehicle damage, Suit by Michael and Jacqueline Wood for vehicle damage/personal injury. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Casperson Claim Supporting Documentation Kinsella Claim Supporting Documentation Klein Claim Supporting Documentation McGrane-Ralston Claim Supporting Documentation Prince Claim Supporting Documentation Ruden Claim Supporting Documentation ScottClaim Supporting Documentation Sisters of the Presentation Claim Supporting Documentation Tyner Claim Supporting Documentation Weaver Claim Supporting Documentation Winner Claim Supporting Documentation Wood Lawsuit Supporting Documentation � �� L �� i CLAIM 1�t�A1NST THE GITY OF DU�UC�UE, IC3VIIA �� I-�?.i� � r��e�u� i This written repor-t cc�n�fiitutes your claim against #h� City of Dubuque, lowa. You should complete this form in �ull and attach any addifiional in�'ormatian thaf supporfis }�our ci�im. The Claim must be filed with the City Clerk at Cify Hall, 50 W: �t3t�' St., Dubuque, IA 5�40'1. It ' will then b� referred by the City Council to the appropriat� dep�rtment far investigation. ' Or�ce th�t ir�vestigatior� is completed, a repc►rt and recc�mmenda�ic�r� will be suk�mitted to the City Council. You will be provid�d with a copy of that r�port and recommendation. THE FINAL. DECISIC}N C}N ALL CC.AIMS IS MAD� BY THE CITY Ct'�UNCIL. NC? EMPLCIYEE �F ; THE CITY t�F DUBUQUE HAS THE AUTHORITY Tt.� MAKE ANY' REPRESERITATI�?N TO Yt�U E AS Tt3 WHETHER YOUFt CLAIM WILL t}R V1��LL. NtJT BE PAID. i 1. Name of Ctaim�r�t:�(��;� � 2, Address: � ��J �`L� � City: l ..�l' lC� ��. _,_,_, 5tate:�� Zip; �� .._ T - —� �. Telephone Nurr�b�r; �� .��`"��i�� 4. C}ate of Incident: ' `�4� ��``� ; � � 5, Time raf Incident; �� W ��..•� � fl 6. �ocatiort of Incident (Be �peci�c}; - �� . �•� �,� �- �- � � � � �� > �� 7. DESCRIBE ACCIDENT OR CiCCURREN�E THAT CAUSED INJURY C}R DAMAGE. {Give � ful� details upor� which you base your claim. (f a City �mplayee vrras ir�volved, c�ive the ' emplc�y�e's nam�.} � � � _.�..,. � �� . �x � �'1�� , c�� j ,��y� -' 1 CC� � �� _ C�� C1'� C� � , ��`'�yl�... 1 1 �� \�w�L.. ` � ��SaYY*�"„g6i 8. What were w�ather condi�ic�ns like? �� 9. Give name and address of an w€tnessesp 1 `�, . � � �� '10. Did c�lice ir�v�sti ate? If so ive n�mes o�c�fficers. �� I� � { , � ) � �� . t .� � � � `I1. Was ar�yone Anjured? {If so, give nam�s, addres�es, and ex�ent of injur�es}. E � �� '12. Was ar�y damage done to property? .{If so, describe prop�rty and the extent of � damages. Attach estimates af damag�s or describe basis fc�r ascertaining extent of � damage.) � ' , � �� 13. VIC�at ather damages do yau claim, if any'�� . � '14. Have you been compen�afi�d for ar�y part or all af yoe�r claim by any insuran+�e compar�y? {If so, give name arod address of insz�r�nce comp�ny and amount paid.� �� 15. What amount do y�a� claim from the Gity of Dubuque?� � "h..s° 5�w�� .. . 1�. V11hy do ytau claim the City af Dubuque is re�ponsible? . �� - ��- '� � � � �i� � � I � � '97. Have you mad� any claim against �r�yc�n� else for damages as a resul# of fi�is ir�cident? � �If yes; give natne �r�d addre�s.} �� g � 9�, If fihe answer to Que�tion 17 is yes, ��ve you r�ceived any paymenfi from fhat sourc�, � and if sa, in rrvl�at amaunt? � � � i��ed ai �u�uq�e, Iowa this � day of �� , 2+D�,�,. �� `� {Signature� s�:�� " --� �,�� . (P 1"1 tl� N cl l"Cl G'} .,� �` � � � � � � � � :.�° �. ,:. � � � '�` � � i {Rf.'V. �J'�"��i} i ; i � Confide�tia[ This cammu�nication and any attachrnents may cont�in information which is confidential �r�d privileged by law and �s for the use of the designa#ed recipien�. tf yau are nat the intended recipient, you are h�reby notified #hat you have received this cammur�ica�ion in errc�r, and that any review, disclosc�re, disseminatiesn, distribution �r copyi�g of its cQnter�ts is prohibited. Please r�otify City of Dubuque imme�diately by telephor�e at {�63�-589-4'120 of yc�ur receipt of these items and destroy the cc�mmunication and any at�achments immediatety. Fur�her disctc�s�re of this informafiion may violate �tate ancl federa! restrictior�s. � �onfidential informatiQn may inc�ude the fallawtng: 1} Social Security Number(s} 2) Medica[1H�aith Inform�tion 3) PersannellC��sciplinary Infarmation 4� Bank Acc�unt Informati�n 5} Financial Informafiion 6} Credit Gard Numbers If any dacumentatic�n you desire to submit t4 the City of Dubuque contains any of the i�err�s ab�ve this �over sheet m�st be attached directly fia the confidential information and indicate the type of infarmatic�n that is included. I, , hereby certify that th� attached documents include the fc�llc�wing prote�ted informatior�: - Social Security Number(s) �ank Account Inf�rmation Nledica!/Health Information Financial Informafiian Personnel/Dis�iplinary Informa�ic�r� Credit Card Number{s) I understand that this information rnay be distribu��d wifihin the City organizatic�n or�o agenfis of the City for processing �nd I h�reby authorize the City �� act �ccardingly t�king all precautions f� protect my ir�f�rmafian fram unnecessary disfirib�atian. �� 1 � -� .� I ��. Sigr� tu Date �;