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Claim by Brock Tyner 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 ��V�� _��i CLAIM AGAINST THE CITY OF DUBUQUE, IOWA '�-�5�.�� 5��5� This written report constitutes your claim against the City of Dubuque, lowa. You should complete this form in full and attach any additional information that supports your claim. The Claim must be filed with the City Clerk at City Hall, 50 W. 13t" 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 copy 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. 1. Name of Claimant: �j�oLk Tyn�.� 2. Address: ��Z. ��`��W�U t��e� City: �MeS State: Z� Zip: .sOUIO 3. Telephone Number: (9�� g�� "'��g Z 4. Date of Incident: �—� � �g 5. Time of Incident: ��p��Si►^^�e-1y �� p+^� 6. Location of Incident (Be specific): ��"�-� ��U�Ule.w �ar�C �G��^-,pc��o�nd S��e., 37 a � 37 b 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. If a City employee was involved, give the employee's name.) ��,�;ng ��0�� c�eo�� -�-c'ek. ti�bS �� on�o r�y Car �e�4-�n� ,�n� ar�� b��k��, W;�.ash�e,�a. _ 8. What were weather conditions like? �� / �a'�^ 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) �, o 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). ! l / � � 12. Was any damage dc�ne to praper�y? {�f so, describe proper�y and the extent c�f ; damages. Attach es�imate� of damag�s or +describe basis far asc�rfa�ning �xfien� of 3 darnage.) �, ,��, ��, t�,�b �t � � �� " t.�J '� t��t ,�e�C� �� a�� i 5 R, � �hi�t�G, w�~e, �e.G.c� ��r�r��'� �,�e� ��e.c��.a�,.c� wiv��e��fi� � � 13. Wha� ather damag�s do you claim, if any? ��nc � ! a � � , �� . y '14. Have yau been �c�rt��aen�ated for any par�t or all of your cMaim by any ins�r�r�ce P c�mpany? {lf sa, giv� raame and address of insurance compar�y and amo�nt paid.} I! �d � � , � : � '95. What amt�un� do yau claim fram the �ity of Qubuque? � _�, 1�0�� * �� . ; G 16. Why do you claim the City of Dubuque is respt�n�ible? ; I� , ;� � � �17. INaue you made any claim against anyone +�Iso for damages as a �esult �f this incid�n�? (If�res., give name and address.) � �� '18. If the answer tt� Gtuest�on 17 is y��, f�ave yc�u received any payme�f frc�t�r� thafi sourc�, :. �nd if so; in what amc�u�t? � a C�ated az �+uk�uque, iowa this' �� day or ,��r'��+�}�-�' , 2�i �� . � . � �C��-�� '°".��- {5ignat�rr�} � _�f�G� I y��c"�" {�'rirtt Name) � � � � e�s f �� -° � � � � � � �Rev. 5/'I8) � � � � � � � � � � � 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 � . � Cor�fiden�ia� � This comtnunicat�c�n and a�y atfiachments may contain ir�formation which is confidential and privileged by law a�nd is fc�r the use c�f the de�ignated recipient. If you ar� not tl�� ; intendec! recip�ent, yc�u are het-eby nc�tified th�at you have receiued this cc�mmunication in � error, and fhat any review, disclo�ur�;, disseminatic�n, distribtation or copying of its conter�ts � is prohibited. Please notify City of Dubuque irnm�diately by telephorte at ��63)-589-4'120 of Q� your rec+�ipt af these items ar�d d�stroy the communicatior� and any attachments E immediately, �'urther disclosure of this information rnay v�otate state ar�d federal � restrictions. � � , , , 4 Confidentia( infiormatian m�y ir�c(ude the following. ; 1) Social Security Number(s} i � 2} M�dic��IHealth fnfiormation � � � � � Ii ;� 3) Persc�nnellL�isciplinary Irr#ormatic�n � 4) Bank Accour�t Information �} Financial lnformatic�n �� 6} Credifi Card Numbers { �i If any document�tion you desire ta submit ta the �ity of Dubuque contains any of the items above �� this cover sheet must be att�ched directly to the ct�r�fidential infc�rmat�on and indic��e the fiype c�f � infc�rrrration fihat is included. 'i 1 Y��" � . (, �`��-- �`? , hereby certify that the attached dacuments ir�clude the following protected infi�rmation: �i � Social Security Number(s} E��nk Account Informafiion � � ;, Medical/Neal�h Informatit�n Financial lnforma�i�n k ,� P�rsonn�I/D6sciplinary lnformation Credit Card N�mber(s} � � I under�tand that this informatian may be distribtafied with�n the City arc�anizatian ar to ag�nts c�f the � �ity far processing and I hereby authorize the Cifiy #c� act �ccordingly taking all precautions tc� protect my inf�rmatian from unnecessaty distribution. , � � ��-- � �� r�' � � _ Signature �ate � � � � i � k ) I