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Claim by Robert Decker Copyrighted February 4, 2019 City of Dubuque Consent Items # 3. ITEM TITLE: Notice of Claims and Suits SUMMARY: Paula Beecher for vehicle damage, Robert Decker for vehicle damage, Eagle Window& Door, Inc. for property damage, Patricia and Lyle Galliart for property damage, John Kirk for vehicle damage, Kelly Keenan O'Rourke for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Beecher Claim Supporting Documentation Decker Claim Supporting Documentation Eagle Window& Door Claim Supporting Documentation Galliart Claim Supporting Documentation Kirk Claim Supporting Documentation O'Rourke Claim Supporting Documentation �� t CL.A[iVl A{�A�N�T THE C1TY �JF DUBUQllE, I(�1NA r ' � �� This written report constitutes your claim a�ainst �he Ci#y of D�buque, towa, Yau should � cc�mple�e this form in fu�l and atfiach any addition�l ir�formation fihat s�pports your claim. ; a The Claim must be fiied w"rth the Gity Clerk at �City Na11, 50 W. 'i��n St., Du�buque, IA 52001. It � will #hen be referr�d by t�e �ity Council to the appropriat� depar�ment for investigation. On�e tha�E inves��g�tic�t� i� ��arn��'�ed, � t�ppo�-t ��:� r�c�mr;��nd�tia� �.i;I be �c�bmit�G� �e� t}�� ' City Council. You will be provided wifih a copy af that repor� and recommendation. � THE F1�]AL DEG(S1flN ON AL.L CL.AfM� IS MADE B�l'THE CITY CC}UNC1L,: N{� EMPLOYEE UF � THE CITY OF DUBUQU� HA� THE AUTHORITY TCl MAKE ANY REPRESENI"ATiON TO YOU � AS Tt) WHETNER YC}UR CLAIM �JVI�L OR W1LL. NOT BE PA[D. � _ _ � '1. �Jame vf Claimant. �� ' � � � , � 2. Address: � � t � ��1r3 5�.�`��`� �� s , i �1��: �2�. _— �t�tG: a�� 1�}: -�c�l..,�t�.`� � �j 3. Telephone Numb�r: _ �� ~ �� r �'�� 4. D�te of Incident. �' � � �- 1� � _ � � � � - • � 5. Time vf lncident: � �` �^� �°�'( �, .� � � r.� _� ��t�.�,� g . ��d � 6. �ocation of Incident (Be sp�cific}: � � � �„a � � � � _ _ � 7. DESCRIB� ACCIDENT OR �CGURRENCE THAT CAUSED [NJURY C}R DAMAGE. {Giv� � futl details ��on which you bas� your claim. 1f a Ci#y employee was involved, give fihe employee's name.} � u � �' � ��...-�r� 1� �/`�,� �` � -�'1��.�.� l��,�` �,r f,�t�.,�� IL�' „�''�� t�� . ��.� .� ��{�" ,1��" ��C�� . What were w�ather cc�nditions like? � � i;�f�0� �. Give narne ar�d address of any witnesses; 3�a-j�� ,��-��.tL-� �,� � .�' � � '10. Dit� �}flIIC� tt�V�St(t„�r��? {1f sQ, �ive names c�f officers.) � i � � � � � � � � � � � --,- . 1'�. '�1las anyon� injured? {If so, giv� names, addresses, and ex�ent o� injuries�. � � � � ` '12. Was any damage done #o property? (If so, describe property antl the extent of damages. Attach estimates of damages or describe basis for ascertaining extent of � damage.) � � � 'y .r� � Z c-�.. ,� �" � � � `)'-Q� ��-1 1L��: 1� _ , ; 13. What other damages do you claim, if any? ' `i"V� Il..��.:- a � 14. Have you b�en compensated for any part or ali of your claim: by any insurance � company? (If so, give name and address of insurance company and amount paid.) �' �, u ,i �� : � � 15. What amount do you claim from the City of Dubuque? >> �� ,I 16. Wh do ou claim the Cit of Dubu ue is res�6on�ible? � � ��' Y Y Y . q p iI ,�.�.. �C.�.. [r 5'.� .�,`1 s` �,✓ .� � �i �.► � 7� / � � 1 �, � � �, ; �I 17. Have you made any claim agains# anyone else for damages as a resul# of this incident? � (If yes, give name and address.) - � �� 18. I# the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? _ ' Ga�ed ai �ubuque, iowa this � day ot �,.1 /q- ' , 2�i�. � (Signature) � �'' �z. h� � � � �� (Print Name) �� '�` � � �- � K�- � �'_.� � � r� +�.� ,�:� ,;, r'� �_ . ��T.� (�2ev. 5/�8) c� � �� .,.�-. .�„ �.... � � � � �� '�....� c� -a- � � � i � � ��f �t}11�1{��1'l�l�� This communication and ar�y attachments may contain information_ which is cortfidentia! and privileged by law ar�d is for the us� of the designated rec�pient. !f yo�a are rtot the ` intended recipient, you are her�by notified that you have received this commur�icatic�n in � error, and that ar�y review, disclosu�e, c#isseminatian, distribution ar copying of its cc�ntents is prohibited. l�lease notify City af Dube�que immediately by t�lephone afi {�63�-589-4120 of � y�ur r�e�i�s� c�f fih�se �t�jns �nd desfiroy ti�� communicatian and any afitachments � imrnediately. Futfiher cii�clQsure af #his information may violate state and federal � restrictions. • 4 � a � Cc�n�denfiial inf�rmafiion m�y incl�ade the follawing: � � � '1) Social �e�urifiy Number(�} � , 2) MedicallHealth lnformatiort �� 3} k�ersannellDiscipiinary Information � 4} Bank Accounfi information ii 5} Financiai Inf�rmafiion � 6} Credit Card Nurnbers a r; If any ciacumenta�ion you desire to s�abmit to the City of Dubuque c�ntains any c�f the items ab�ve fihis cover shee� must be �ttached directly to the canfidential finform�tion and indicate the type �f � inforrnatic�n th�t is included. � � � , � I, , hereby certify that the att�ched dflcum�nts � include the foll�wing pratected informatic�n: r �c�ci�l Security Number�s) Bank Acc�unt Infarm�tian I� , � MedicallHealth In€ormation Fin�r��ia( Informatian E Personnel/Disciplinary lnformation Credit Card Num�er{s) � 1 understand th�t this informatic�n may be distributed wifihir� the City �rganization or to agents c�f the � City for processing at�d 1 hereby �uthorize tf�e Gity to �cfi accordingly taking all prec�utio�s to � _ _ protect my informati�n from unnecessary distribution. ' I �:�1� � �� 1 °�-� � � �- °' �� Signafiure D�fe Copyrighted February 4, 2019 City of Dubuque Consent Items # 2. 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: Paula Beecher for vehicle damage, Robert Decker for vehicle damage, Eagle Window& Door, Inc. for property damage, Patricia and Lyle Galliart for property damage, John Kirk for vehicle damage, Kelly Keenan O'Rourke for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo THE CITY OF t�B � � E MEMORANDUM '� Masterpiece on the Mississippz � ,� � !� I �ACEV �� CKL � IN ' �l PARALEGAL �� i� To: Mayor Roy D. Buol and ;' Members of the City Council �i ,�i DATE: January 24, 2019 �; �� p� RE: Claim Against the City of Dubuque by Robert Decker i', il Claimant Date of Claim Date of Loss Nature of Claim j� ,� q � Robert Decker 01/22/19 01/19/19 Vehicle Damage �t I!I This is a claim in which claimant alleges that his vehicle which was parked on near 150 South Grandview was struck by a City snow plow truck. � �� This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa I Communities Assurance PooL I; I cc: Michael C. Van Milligen, City Manager � John Klostermann, Public Works Director u Robert Decker '� y � � 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