The URL can be used to link to this page

Claim by John Kirk 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 MVM Legal CLAIM AGAINST THE CITY OF DUBUQUE, IOWA Public works 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. NameofClaimant: �d�� /�,"r,� 2. Address: Z Z �`.� Ca r�er- �U City: »p ��N� State: �°'w.�- Zip: ��°a I 3. Telephone Number: 5�6 3 ' �`�.5� � /3/� 4. Date of Incident: l ' � �l � / �' 5. Time of Incident: G �3v /�"' 6. Location of Incident (Be specific): ,(/'o�f� oa�/��-y /o�- ar ow�/�� w,y/�s 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.) />r�Q+� ry��'�G,C ah�C W a S �p �OG.ri�g .I��-c � ai�C,"�a9, �o r Ct f'�"�-e ��duL/�r .�...�/rs � �9rr O vral /J�v Ca� t� f'�t o�t'fl�� S%��e o��'�c ir.r�'�s /o t, l�i�e e�►�'y��y e/sc � � �.-c- /.t- N.4s zo�+'. 8. What were weather conditions like? .Lc � d` �'h o� 9. Give name and address of any witnesses: — 10. Did police investigate? (If so, give names of officers.) 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). — 12. Was any damage done to property? (lf so, describe properfy and the exten# of � damages, �tfiach estlmates of damages or describe basis for ascertaining extent o# ; dama�e.) � S�� ,f�f f�ol ,„�.�" � � 13, V9(hat other damag�s d� yc�u claim, ifi any? �" � ; ; # � 14. Have yc�u been compensated for any part or a11 of your claim by any insurance ; c�ompany? {1f so, give narne and address c�f insurance company and amoun# paid,} �� ' u , � 15. What amount da yr�u clairn from #he City of Dubugue? �1 $ .2.,, �'s ;>`I 7� . i� �18. Why do you claim the City of Dubuque is responsible? �� -----. �T_. h��+�anr/ v� crtr l, rog�t�-� ` � —�� I� 17. Have you r€�ade any claim against anyane else for damages as a result of this incident? � (lf yes, give nam� and addres�,� �� 18. lf the answer to Questian 97 is yes, have you received any payment from that sr�urce, and if so, in what amount? � � '� ,,, ' I� � Dated at Dubuque, lowa this �day of ��"�°`� , 20�. �� r T � {Signature) '�a�,. �•f-� {Prir►.t �I��r�) � C� c� ,--�� cMz. :.�:' {R�v. 5l'f 8} � �� "€ � � � ; � �� .�� ;,'- � ��,e _ €._��1 f� �� :� x�„;.,. - r--; `..:�. --�. � � p �� C�l.i ;,,� �_�.i ��.a 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, -� dti� 1C,'j''/� , 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 - � 3 -/ � Sign t re Date 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 I�UB �TE MEMORANDUM Masterpiece on the Misszssip�i ' ; �I TRACEV STECKLEIN '��ll�' � PARALEGAL "� �� To: Mayor Roy D. Buol and Members of the City Council ' DATE: January 25, 2019 � � !� 'I RE: Claim Against the City of Dubuque by John Kirk I!� , , � Claimant Date of Claim Date of Loss Nature of Clairn �� ii John Kirk 01/25/19 01/19/19 Vehicle Damage '�1 II� This is a claim in which claimant alleges that his vehicle which was parked in the Municipal i� Services Center parking lot was struck by a City snow plow truck. � li This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa � Communities Assurance PooL `�� ,;I cc: Michael C. Van Milligen; City Manager � John Klostermann, Public Works D�irector � John Kirk � !I I� � 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