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Claim by Morgan Weaver 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 �� G�- �- ��iA YJ 1�C. �(;�l"�S CLAIM AGAINST THE CITY OF DUBUQUE, IOWA p6�� 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 5200'I. It will then be referred by the City Council to the appropriate department for investigation. � Or�c� tha# ir�v�s#igati�r� i� �ornple#�d, a repor�t and recornrner�dati�r �iIL be subrv�itt�d to #h� � 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 1'HE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU AS TO WHETHERYOUR CLAIM WILL OR WIL.L NOT BE PAID. , 1. Name of Claimant: � � 2. Address: � '� � ;; City: ^� State: I� Zip. �i�� ' I 3e Telephone Number. t t ~� �`' � 4. Date of Incident: � ,� 5. Time of Incident: �° �� 6. Locati n of Incident (Be specific): � ��" �° {� � 1 ��l ��, � P I �/ l/�6d1J v0l�i�'� �� 1 �, � I 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. ((3ive full details upon which you base your claim. If a City employee was involved, give the employee's name.) � ' � �� '�'��'��r $ -�. e , ��, �� 8. What were weather conditions like7 �� 9. Give name and address of any witnesses: � �( ° `� � � � � 10. Did police investigate? (If so, give names of officers.) � � � � �,; 11. 11SVVas anyone injured? (If so, give names, addresses, and extent of injuries). �� '12. Was any damage done fic� praperty? {If sa, describ� proper#y �►nd �th� �x�ent of damages, At�a�h estimafies flf damages or describe basi� for asc�r�a►ining extent o# damage.} � � �� 1 � �� 3. Wha�t other damages do yc�u claim, if any? � � � � 14. H�ve you been compensated for any par� ar aNl of your claim by any in�urance � company? {lf so, give name and address of insc�ra�ce compan�r and arrnaunt paid.) , � � ` � � � 5. W t annc�unt you �[�im from the Ci of Dubuque? � �. � �~- � � � � � '16 h do u c�im t�e City �f D�abuque is respernsible? � '17. Have you made any claim again�t anyone el�e fc�r damages as a result caf this incident? {If yes, giv� name and address.) � '18. If t�e answer to Question g7 is �res, have yau rec�ived any payment frann that so�rce, and if s�, in what amo�ant? �. Dated at Dr��uque, iowa this � day c�f � � , 2��. `'� �Signature) `'�..��1� �Print Name) ,...�f �� M _�,; � � : � ��. P,.-... � � =� � �--y; ,';;, �� _-�- y� �� ,, (Rev. 5118} � t�� .�" ,�;� Confidential This communication and any attachments may contain information which is confidential and privileged by law and is for the use of the designated recipient. If you are not the ' intended recipient, you are hereby notified that you have received this communication in error, and that any review, disclosure, dissemination, distribution or copying of its contents � is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of � your receipt of the�e i#er�� and de�#roy #he �orn��r�ica#icn and �re� a##achrr�en#� � immediately. Further disclosure of this information may violate state and federal " restrictions. � � Confidential information may include the following: 1) Social Security Number(s) �f 2) MedicaUHealth Information i 3) Personnel/Disciplinary Information � 4)� Bank Account Information 5 Financiallnformation ) 6) Credit Card Numbers '�� If any documentation you desire to submit to the City of Dubuque contains any of the items above this cover sheet must be attached directly to the confidential information and indicate the type of ��; information that is included. I I, U , hereby certify that the attached documents j include th following protected information: I i Social Security Number(s) Bank Account Information ; I Medical/Health Information Financial Information PersonneUDisci linar Information Credit Card Number(s) P Y I understand that this information may be distributed within the City organization or to agents of the �� City for processing and I hereby authorize the City to act accordingly taking all precautions to ', protect my information from unnecessary distribution. ' a � �� Sign re 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 the Mississippi TRACEY STECKLEIN i� PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: September 11, 2018 RE: Claim Against the City of Dubuque by Morgan Weaver Claimant Date of Claim Date of Loss Nature of Claim Morgan Weaver 09/10/18 09/04/18 Vehicle Damage This is a claim in which claimant alleges that a Public Works employee struck claimant's parked vehicle with the spray bar on the Public Works vehicle on Alta Place just south of Delaware Street. 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 John Klostermann, Public Works Director Morgan Weaver OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/FAx (563)583-1040/EMAi� tsteckle@cityofdubuque.org