Claim by Jason Drolema Copyrighted
January 7, 2019
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Dittmer Recycling, Inc. forpropertydamage and Jesse Drolema
for vehicle damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto CityAttorney
ATTACHMENTS:
Description Type
Dittmer Recycling, Inc. Claim Supporting Documentation
Drolema Claim Supporting Documentation
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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: SCsse 1��d1E�n�
2. Address: 3� 3S W tt��wurt b r.
City: �,1��c��� State: Sa Zip; Sa�01
3. Telephone Number: s� 3 ��J G$9•�
4. Date of Incident: Stp�l- / �, ���� S��} ha�rPc� ��y M�rC f:�►ty �
5. Time of Incident: I�� vc� novr
6. Location of Incident (Be specific): ���4 S'r'rtE�- �po�l��n� �t,�w��p.
���'�ha� � '��-{Icr p��kM� . Sp a-}' /y�/
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.)
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�h i'��Gk , Wqirtt I�as Calc�w�r�/ Skl� Ca��CS c�a�a.qt �-�o ��oG�.
8. What were weather conditions like? Rt��n
9. Give name and address of any witnesses: R�iS S'�'CGk�C�n
10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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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p��^�' vn �nn� �� � C� ��( S�c�t �j✓wr�( ��G� . M:�c�,c,16 tlttZ
13. What other damages do you claim, if any? v�n°.�,�t�C }w�Sta �ti y��- �tiE i�:n
L� �- b�rZ- wc� Gda+- c�or� �, �cy 1�,��, #m c�-�w 4�c . ��si- uz�t �
pco - C1�1� Z=2 �nui- CC n�ovt si-�;.,n •
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.)
� o'�' �G�-' t CC�c�p�S ca.�'C�[.�•f.�.
15. What amount do you claim from the City of Dubuque? ��.
� $ 3 .
16. Why do you claim the City of Dubuq�ue is responsible?
.x w�.� a bt� �i�o was�. �.t '�r,�z� c�•► lt ov-�, w as aikc� Mov� ko
pv���C. tu�l��n� � �`,�X �r'b�E.�"• 'Sa l�. �o /v�.vvt bwL1c. � ��' 1�a�pCwtJ t��A'•� i h 'W{t��'
17. Have you made any claim against anyone else for damages as a result of this incident?'f+��t f��t
(If yes, give name and address.) Cauc��+y
N'v �aw��.u�c,
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 1� .
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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 these items and destroy the communication and any attachments
immediately. Further disclosure of this information may violate state and federal
restrictions.
Confidential information may include the following:
1) Social Security Number(s)
2) Medical/Health Information
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, , hereby certify that the attached documents
include the following protected information:
Social Security Number(s) Bank Account Information
Medical/Health Information Financial Information
Personnel/Disciplinary Information Credit Card Number(s)
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.
1 { - l � I/ �
Si nature Date
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VI
Copyrighted
January 7, 2019
City of Dubuque Consent Items # 3.
ITEM TITLE: Disposition of Claims
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: Dittmer Recycling, I nc. for property
damage; and Jesse Drolema for vehicle damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Supporting Documentation
THE CITY pF �,.,
�LJB � � MEMORI� NDUM
Masterpiece on tFae Mississippi
TRACEY STECKLEIN �
PARALEGAL I
To: Mayor Roy D. Buoi and
Members of the City Council I�
�
DATe: January 2, 2019 !'
RE: Claim Against the City of Dubuque by Jesse Drolema �
'�
Claimant Date of Claim Date of Loss Nature of Claim I
I,.
Jesse Drolema 01/02/19 09/12/18 + Vehicle Damage
�
i�
This is a claim in which claimant alleges that calcium salt droplets fell onto and damaged �I
the hood of claimant's truck while parked in the City of Dubuque lowa Street Parking ��
,
Ramp.
�
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
Russ Stecklein, Transportation Services Field Supervisor
Jesse Drolema
�
�
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/Ennai� tsteckle@cityofdubuque.org