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Claim by Daniel Scott 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 - . �I ��,r�L N �r ��s��- � CLAIM AGAINST THE CITY OF DUBUQUE, IOWA -�� This written report constitutes your claim against the City of Dubuque, lowa. You sh u�d� complete this form in full and attach any additional inforrnation that supports your claim. tn � The Claim must be filed with the City Clerk at City Hall, 50 W. 13 St., Dubuque, IA 52001. It � will then be referred by the City Council to the appropriate ,department for. investigation. � Once that investigation is completed, a report and recommendation will be submitted to the �� City Council. You will be provided with_a eopy 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. � i i� .--- � , 1. Name of Claimant: �c,�,^� p,�,�,. �C' c� '� � 2. Address: �[ � ' � l,� �ii � � �� City: ,�/i.c �c,a-��P State: _L-Q�� Zip: � 2lJd l ��; 3. Telephane Number: ,��u�' a2a�'f� /Q�� /Vlodlp ��v� � ,�C.� — 8��''l N ,, . -. ,, , , , � _ 4. Date of Incident: "-�--`_ ,. �� .E-�,; 2��Q I - � � �— � ; . I 5. Time of Incid,ent: ��„s� _, � �t� 1�!'!�J � ' � 6. Location of Incident (Be specific): � (d i �'Ue �„ � � p � � � � � � '� � !l��t. � 7'�' Q�. �`��1 e� i � N 7. DESCRISE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give ' full details upon which you base your claim. If a City employee was involued, give the � employee's name.)�-t'�,� �S'��e. '�w� �ro�re.r. � e� -�0 4�,�.vv,� o��,�. b�,►s �� P` �°,'Yl P_.e!s Q.1�G f!� c,s/�@d�►r' Co evt G � `�'h�e, �ar�"!� o '-� -�t� �.s /!�. �/e��r�rC Le� �.�f� J- w � $- C�o ` ri .t � �y s` I" I'� c�ro�n� nti�. �' �h� � I�e c�,"d...1.-� c�.�sed W a�-er �. n�. ev��s- � y`� - o-�- l ` 1te�1c `�- _ -E- -� ! t� ��rs.� �e4°a r R P�''s -�aJ ��,.� �-�,X w�y cf�r r 8. What were weather conditions like? � ` « Q� ` u - , -�'� 3�/� lrr,ur -�-h�. �'i`r6 k��'t' �/�e �D � a w�;�a.�d �y c�hai� ��°e �ca(t;� t��I� 9. Give name and address of an y witnesses: 't al,c.e. (�'�;c,.,eK�aSz4.1'�'.7��►,vao�� Pa�ie.�. �y 10. Did police investigate? (If so, give names of officers.) s Q�l'��.°C� �QS'I1�c t54��"�CGP GL^�"��2.`�jG?E�.(�. .�i'W �'p6��'C� ! ,G�4 P-�s ' , `7C1'jGp.� .3��n. �i9�C.�11'V!� W� �Q! /'�/s�1�0�� f�� t�tr�fG« . %�jQj'CGJi'� p 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � �=L„ /c+t� sho� �cler 'rn;,�ru ��'�..S�F S'oF�� I 12. Was any damage done tc� prop�rty? {If so, describ� property �nd the ex��nt of darnages. Attach estimates of damages ar describe basis for as�ertaining ex#�r�E of damage.} i r a t` � �4 G�h�� !tti C� � w� �� G� �-r�ss, .�C '►��.�►�.�+�.� be��: 5'-��k.�� . ;p�.nn �� "��d�y �9 .��, � o ��- 5'��ed G.��.e- �n�4ge,� c�.nct C!o�st' � ��a lrrve ��e e. t�he��`r �:� —�► , '13. What other damages d4 you claim, if any? t�� a,��. ��,-,�� _��a�� °�'e� ��.� u.'cd e,,�c�.r�r`,�� o��. Cr��'�i�r'r- 14. H�ve you been compensafied fc�r any parfi or �11 of yc�uir,claim by any insurance � company? �1f so, give name �nd adc�ress af insurarace campany ar�d arnount paid.) � �� 1�. Whafi ar�c�unt do ou claim frc�m the Cit �f Dubu u�? � Y Y q ��} ,�.fl . �` �. , ` � I �'a �,�,� �c� �.�r.�.a��r �'ram `�s a,r�-d w�tkk�" � ?�r.��`n��,�`c�-�'' c�.t--�i.e �h.�F rµ 16. Why da yc�u cla�m the City of Dubuque is re�ponsible?� . ;��d�,-1� � � � ; , � _ � �� a /�e �61�l� �"d'1�� p'tt s'� ►�C. � '�"'r ��,`�" S� 1�te.-�Ct{ �.� ��tt-�t�e�� i � 17, Have yc�u.made any cl�im a�ainst anyone else for dam�ges as a result of thi� incident? ' {If yes, give nam� and addres�.} ° � �t� � , � 18, [f th� answer to Questi�r� 17 is yes, have y�u rec�iv�d �ny payme�t from that saurce, � and if so, in what amount? rVI�- T' ' � �a�ed a��}u�uque, iowa this tt day of ��, r�+�.�^�je� , �0 I �t`, � �, _ a..� � �' , ,_ . � � � :� � � � � _ , � �r, -� � . �Signature) � c� �, �'� � . � .. . ,, � � � � � � � � �ff�'an;�.r � " . �co� t�rint Narne) �,,, �` -�e r�e.e��,-� �s i� �� ,r� ��, �t/ac� �`"` d��e� w��` �� `�c -�t�� ,' ;yt�`;t� ��e �1��-��►� �� C��.crf �&�nf� .�-a �e. �,rr,�t's��'+� /a �HF ,-l-"Q t- '�.+�. �v+��:e�.�, � -�-a .�-c��...:ra�,.�`_ ta� Sc�u��"►�� (�ev. 5l'1�} r i �,��fit��,�, �"'/�Z , ; ,� �, ��, `�,� —�-� J��- c�r� ��t� ��.- ��Z�'��'� � �� Ca na,�- r°o r,� 2�W` �,�, � c�.nad c�� h r�m�h ��.e c�i�'S c��,�+n��.. Co�' �1��. ��'A ' � 0 , � i � � i I i i k ! _ E I � i 4 h r ti t � i Can�`identia[ Th"rs cummunication and any attachments may contain information which is conficl�ntial anc! privileged by law a�d is €ar the use af the de�ignated recipient. if yc�u are not the intended recipient, you are hereby not9��ci that you have rec�ived �his cam'munication in errar, ar�d fihat any r�view; disctosure, dissemination, distribution or copying af its conten#s is prahibited. Please natify City af Dubuque immediately by telephone at (563}-589-4'12Q af your receipt of these items and destray fhe communi�ation and any afitachments immediateiy. Further disclosure af this informatian may vic�(ate state and federal restrictians. � � � Canfidential infarmation may inc(ude the following: i 1) Sc�ci�1 Securifiy Number{s} ' 2) Medical/Health lnfr�rmation �; 3} Personnel/Disciplinary lnforrnativn �! 4� Bank Account Infarrnation ! 5) Financial Informatian � '„ 6} Credit Card Nurnbers � �; If any dacurnentation you desire fio submif to the City of Dubuque con#ains any af the items �bove � thi� cover sheet musfi be at�ached directly ta the cc�nfidential information and indic�te the type of � informatic�n tha# is inciuded. 'a a a � N �' !, �c�,+t# � � .�, �� , hereby cerkify that the attached dacuments �� iriclude the fa1lowing protected informatic�n: � � �� ocial Se�urity Number(s} Bank Accaunt lnform�tion � � Medic�liHea(th fnformatic�n Financial Enforrnatian � �� , r P�rsc�nnel/C7isciplinary lnformation Cr-edit Card Numi�er(s} I undersfiand that this infarmati�n may be distributed within the City organ'rzatior� or fiQ agents of the City for prc�cessing and I hereby �uthorize the City tc� act accordingly taking aii precautions to protect my information from unnecessary distribution. � . � � �� ~�'e�.�.� � t-�h 2� l� � Signature � Dat� � � � � � Copyrighted September 17, 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: William Baum for vehicle damage, Jerald Kinsella for property damage, Gerald Klein for property damage, Lynn McCormick/Partners Mutual Insurance for vehicle damage, Abby McGrane-Ralston for vehicle damage, David Prince for vehicle damage, Steve Ruden for property damage, Daniel Scott for personal injury/property damage, Sisters of the Presentation for property damage, Morgan Weaver 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: September 11, 2018 RE: Claim Against the City of Dubuque by Daniel Scott Claimant Date of Claim Date of Loss Nature of Claim Daniel Scott 09/11/18 09/05/18 Personal Injury/ Property Damage This is a claim in which claimant alleges his shoulder was injured and his electric wheelchair was damaged when he was dropped off at a wet grassy area of a Jule bus stop.. This elaim 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, Transportation Services Field Supervisor Daniel Scott OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA Su�TE 330, HARBOR VIEW PLACE, 3O0 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/FAx (563)583-1040/EMai� tsteckle@cityofdubuque.org