Claim by Jeffrey Kostein Copyrighted
October 15, 2018
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Jeffrey Kostein for property damage, Lindsay Lannen for
vehicle damage, and Andrew Topping for vehicle damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City
Attorney
ATTACHMENTS:
Description Type
Costein Claim Supporting Documentation
Lannen Claim Supporting Documentation
Topping Claim Supporting Documentation
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ���' ��� -
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This written report constitutes your claim against the City of Dubuque, lowa. o sfiould
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.
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1. Name of Claimant: �.� �'
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2. Address: ��� � ��� C.i���c� ,
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City: � � t���� State: ����_ Zip: �� � � � . �
3. Telephone Number: ` �'���` � ;� 1'7 lYi n � "' �����5�
4. Date of Incident: 1 � � ' 1 � � �
5. Time of Incident: �'�� 1� i- . r�l ,
6. Location of Incident (Be specifiic): �1 ���'(� � 1 i,��_1�;'� B L�.�� ���.1� , C�t(����
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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
emplo��'s name.)
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8. What were weather conditions like? C " � f�np.
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9. Give name and address of any witnesses � � �� �� �'�� �
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10. Did polic inv.e�tigate? (If so, give names of o icers.) . ;l C� I� �
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries). J
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12. Was any damage done to property? (If so, describe property and the extent of
damages. Attach estimates of damages or describe basis for ascertaining extent of ,
damage.)
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13. What other damages do you claim, if any? I�v� �l�_�
14. Have you been compensated for any part or all of your claim by any insurance
company? (If so, give name and address of insurance company and amount paid.)
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5 t a y a t e ty • ubuque.
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16. Why do you claim the City of Dubuque is re ponsible? ,
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17. Have you made any c�aim aga�nst anyone else�or dama�es as a result o�#his inc��ent?
(If yes, give name and address.) ��
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18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, lowa this day of , 20
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Copyrighted
October 15, 2018
City of Dubuque Consent Items # 3.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: CityAttorney advising that the following claims have been
referred to Public Entity Risk Services of lowa, the agent
for the lowa Communities Assurance Pool: Jeffrey Kostein
for property damage and Andrew Topping for vehicle
damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Staff Memo
THE CITY C}F
U� � MEMORANDUM '�
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1V1c�sterpiece an the Mississippi �
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TRACEY STECKLEIN ��
PARALEGAL �
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To: Mayor Roy D. Buol and ,�
Members of the City Council �
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DATE: October 1, 2018
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RE: Claim Against the City of Dubuque by Jeffrey Kostein �
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Claimant Date of Claim Date of Loss Nature of Claim q
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Jeffrey Kostein 10/01/18 09/02/18 Property Damage i
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This is a claim in which claimant alleges that during a storm, a branch fell onto daimant's �;
trailer which was parked at Miller Riverview Park Campground, Site 13B. �
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This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa r
Communities Assurance PooL �
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cc: Michael C. Van Milligen, City Manager I
Steve Fehsal, Park Division Manager �
Tom Kramer, Urban Forester
Jeffrey Kostein �
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OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TE�EPHONE (563)583-4113/F,vc (563)583-1040/Ennal� tsteckle@cityofdubuque.org
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