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Claim by Robert Krohmer Copyrighted February 18, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Trever Allen for vehicle damage, Brian and Dee Collins for property damage, Robert Krohmer for vehicle damage, Eric Mueller for property damage; lawsuit by Jerry Brandenburg for personal injury. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Allen Claim Supporting Documentation Brandenburg Suit Supporting Documentation Collins Claim Supporting Documentation Krohmer Claim Supporting Documentation Mueller Claim Supporting Documentation ,�VI�� CLAIM AGAlNST 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. 13th 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 C1TY 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: �e�,�'�`� �,�v�.�`�`-tiZ 2. Address: \Z�ZS ��t�� "r►e�� City: L�v3v��•�� State: 1� Zip: .SZcC� � 3. Telephone Number: �� - '2-_1'�-- �� 4. Date of Incident: C�Z�o S �Zc�t`� 5. Time of Incident: i � �i�� 6. Location of Incident (Be specific): � `ZZ.�� ,'�� J� �'��LE��.�,�L r'�v'� ,�� 5'Z�;L-_1 L-��1T ti�r�5t '�Ol<<�� C�.�-' L, "Z.Z�' '� \• 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.) �� Pc iE�Z t-��t'�� wc� �,.� c:_,��`� �l�t{�t�.� +..a �Ua;�D ;�T SioP Lt�T �:�.s�22,�_ 5�, i-�c �,�_ �tct��c.LL 1�..� ��V�.-�`�c qrl� �A��1�� T"� �� vCt1�C� ZiIA"� S�o�2C� �iLr4i,;� �l'��' 8. What were weather conditions like? �,vel� f 5�-cc.� 9. Give name and address of any witnesses: -�-- 10. Did police investigate? (If so, give names of officers.) ;c� -�Ko��S�� I t��c��.�i 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). �� i [ �12. V11as any damage don� to praperty? {If so, describe proper-ty and the ��tent af damages. Afitach es�irna�es of damag�s or describe basis for �scertainir�g extenf of damage.} � � ``��'� � �Q�}.t�i ��..iL.L �f'J Zt`'t t} � �ry�1 �,R�'�'k'� �c * � . J-�� d�^� � � �a�t�:- �t � � �i �t� n it�`� ��,,,�` P-,v s�Q��-�cx.-,, �.r��t� - � � '�3. What o�her damages do yeiu claim, if�ray? ' � ; ; _ � � � '14. H�ve you been comp�nsated for any pa�t or a�1 of yaur c�aim by any insurar�ce ;� ct�mpany'? �If so, g�ve narn� and address of insurance cc�rnpany and amount �aid.} �;i a , , �� '15. What amc�ur�t do you claim frc�m the City c�f D�abuque� � � �� 1 g � 'i6. Why dc� you claim the City of Dtabt�que is respc�nsib�e? : ; � �' c,��A� �� . �°�-��e ��1`� • C'��.�`� � tc..�.-�. ��'...�, °a�°�� 1� �a _ ° � � '17. Have yo�a mad� any cl�im against anyou�e �Ise for damages as a resul� c►f this it�cident'? � {lf yes, gave narne ar�d address.) � � � � 1�3, tf the answer to Questi+on 17 is yes, have yQu received any paym�r�t frorn thaf saurce, and if so, in what amc�unt? - � � . � .�'7��f� �L �UpUC[�]�, iowa this (�� day o� �=�:�, , 20 �`� . � � � �"`l, ��,�� {aignature) � � � .��, � � �- C`� � ��,'�` ��.�� Print Narne ..� �- ! �� k ( ) � � �� ; 4 �� (�e�, 5l��} Confidential This communication and any attachrr�ents may con�ain informafiion_ which is confidential � anc! privi(eged by Iaw and i� for the use of the designated recipient. If you are not the R in�er�ded recipient, you are hereby notified fhat you have receiv�d fihis cammunication in � error, and that any rerriew, disclQsure, dissemin�tic�n, disfributic►n or copying of its confients � is prohibited. Please natify City c�f Dubuq�e immediateiy by tele�rhane at �563�-589-4�i�0 �af }�� rec�apt �a#' �he�� it�r�n� a�d des�ray �h� cot�imunicafiion anc� any afitachm�nts � �mrnediately. Further disclosure af t�is informafiian may violate state and federal � resfrictions. . . � � � Confidential infarrnation may inc(ude the folEowing: � '� 1} Sc�cial �ec�rity Number�s) � 2) MedicallNealth Informatic�n � 3) Personne}JDisciplin�ry lnformation . � 4) Bank Acco�nt Infc�rmatian � 5) Financia( Information � 6) Credit Car-d Numbers � , Efi any documentafiion yo� desire to submit to the City of Dubuque contains any af the items above � fihis caver sheafi must be attached direc#ly to the cQnfidential information and indica�e the typ� af � infc�rmatior� that is inciuded. r � � N '� l, ��.1 ��-��l�.�. , hereby �ertify that th� attached docurnents '� include the faliQwing protect�d �nformati�n: � Social Security Numb�r�s} Bar�k Acce�unt Informatian Medica(IHealth Infarmation Financial lnfc�rmation � � PersannellDiscip(inary finfc�rmation Credit Card Number(s} � � I understand that this information m�y be distributed within the �ity c�rganization or to agents of the � City for pro�es�ing and 1 hereby authorize the City to act accordingly �a4cin� a11 precautions ta � ____ pratect my infc�rmation from unr�eces�ary distributi4n. � � � �� - signature D��e � � ', Copyrighted February 18, 2019 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: Trever Allen for vehicle damage; Brian and Dee Collins for property damage; Robert Krohmer for vehicle damage; and Eric Mueller for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation THH CITY QB �T.J� � MEMORANI� UM Mc�steYpiece on the Mississippi TRACEY STECKLEIN �� PARALEGAL a �To: Mayor Roy D. Buol and , Members of the City Council I I�DATE: February 11, 2019 � �I RE: Claim Against the City of Dubuque by Robert Krohmer '� ,� Claimant Date of Clairv� Date of Loss Nature of Claim I!, Robert Krohmer 02/08/19 02/05/19 Vehicle Damage �� This is a claim in which clairroant alleges that when a City of Dubuque police officer I, attempted to make room for a turning snow plow truck at the intersection of 22nd Street I and Central Avenue, the officer backed his vehicle into claimant's vehicle. � � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa � Cornmunities Assurance PooL cc: Michael C. Van Milligen, City Manager Mark Dalsing, Chief of Police Robert Krohmer �� , 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 ! �