The URL can be used to link to this page

Claim by Robert Sigwarth Copyrighted March 18, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Joseph Burbach for property damage, Matt McFadden for Mak's Bait Shack for property damage, Roeder's Outdoor Power/James Roeder for vehicle damage, Robert Sigwarth for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Burbach Claim Supporting Documentation McFadden/Mak's Bait Shack Claim Supporting Documentation Roeder's Claim Supporting Documentation Sigwarth Claim Supporting Documentation �. �I3c'icun ��,��1. �vcc�c�.n. �,,� � �,.ri' 1�.�' �" �-�„r ""`" `�` � 5�.��r.�'` �`�� `J l,M,_a �o►t��'a�r�S �. �� CLAIM AGAINST THE CITY OF DUBUQUE, 1010VA �'' ��"'��S � �. �a.:,�.� d 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. y G 8nce 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. ;', i�� 1. Name of Claimant: �� °��+�� I' 2. Address: �� 'ti�� C' a ��. � ��c�e�� !� ji 3. Telephone Number: ��- �� '�'��Y '� i �—��-�C7r� i 4. Date of Incident: „ G 5. Time of Incident: I�_� �I�0 !; �I i 6. Location of Incident (Be specific): ��C ��+`�< � �.;a°� � � ! �t�- - �f`� ��.�,�. ii 4 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DA�iIIAGE. (Give i! full details upon which you base your claim. If a City employee was involved, give the � employee's name.) �',� _ -� �1�s �a�� `� a-o .Q,; `� � �-i� � � �-� `,�� j �Q1a<� ��_ ��,�;�cl 'r� � �� . ; 8. What were weather conditions like? ��-��` � 9. Give name and address of any witnesses: ��- � � � 10. Did police investigate? (If so, give names of officers.) �Q ,(")�1'� � � �v�!�o�� i� �a�',�r�,� i o 1 . 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � � � � � � x � � 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.) 'C J��,� 1jt..vti. � �!' C��b f �� (.�'k-c�� G�i,v�M:� 5�(J�IY�� 13. What other damages do you ciaim, if any? � � � i 14. Have you been compensated for any part or all of your claim by any insurance u company? (If so, give name and address of insurance company and amount paid.) i i: ��LS C��'�.f�et �.�.'v1`SeAJ'cz.�C'�T l�dC��a1f.� � ��\n.J'C��.�? ��l.G�f.Q L4-�irP�r� ��i ��(�c� � � � �� '��' • ��J ��.� �� C��a-J ,�wi. �,r�.� �r3a��110 ��!. ��P�S� (�e�%.c�: �l�f'��G�f"J. 1 15. What amount do you claim from the City of D�r�uque? �I �a�C.��. 3`ai i, ' ''� 16. Why do you claim the City of Dubuque is responsible. ��3� �e�e�c�� 'r��l�l �� ,�G�' �� .��y,.cf;�,,�, �'o� �d✓�� '�"'�P l��;��,�o ''i � ;h �; 17. Have you made any claim against anyone else for damages as a result of this incident? la (If yes, give name and address.) !�� ,�/� �;j � 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 !� . � i1 8 � h �,,, u � � � �� (Signature) � � � .--- � �-¢- ) � . , U ,�' J �.l � �� UC��l� (Print Name) � � � _._ � � ,;��, � � a � �;�- `.�' I`�i s� �,� � � (Rev. 7/12) ��;, � � � � ,�.° c� �, � � � � � � Confidential This communication and any attachments may contain inforrnation 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 1 your receipt of these items and destroy the communication and any attachments �5 immediately. Further disclosure of this information may violate state and federal '� restrictions. �h � j, il Confidential information may include the following: " ;, 1) Social Security Number(s) � !' 2) Medical/Health Information � 3) PersonneUDisciplinary Information �; 4) Bank Account Information ! 5) Financiallnformation �, 6) Credit Card Numbers ;; ;I 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. Please indicate below the type of information that is included. 'i i; I, �� -�� , hereby certify that the attached documents � inciude the foliowing pra�ect�'i�rfc�rr�n�ti�n: i� ; Social Security Number(s) Bank Account Information i ��. p Medical/Health Information Financial Information � Personnel/Disciplinary Information Credit Card Number(s) �� i ,� ij I understand that this information may be distributed within the City organization or to agents of the i City for processing and I hereby authorize the City to act accordingly taking all precautions to I protect my information from unnecessary distribution. r 7 � '---�- _. d� �� Signature Date I have read the information above and do not have any confidential documentation to submit to the City of Dubuque as part of this Claim Against the City. � 4--- ._ � �� ig ature Date I � � Copyrighted March 18, 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: Joseph Burbach for property damage, Hope Ehlinger for vehicle damage, Zachary Hallman for vehicle damage, Matt McFadden/ Mak's Bait Shack for property damage, Roeder Outdoor Power for vehicle damage, and Robert Sigwarth for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation THE CITY OF L�'�,TB E MEl�IORANDUM Mc�sterpiece on tl�e Mississippi �i �� TRACEY � STECKLEIN � PARALEGAL � ^� To: Mayor Roy D. Buol and ; Members of the City Council a DATE: March 13, 2019 RE: Claim Against the City of Dubuque by Robert Sigwarth ,� !I Claimant Date of Ciaim Date of Loss Nature of Claim �,j � Robert Sigwarth 03/13/19 02/25/19 Vehicle Damage ;� i This is a claim in which claimant alleges that as he was waiting to exit the parking lot at 'i 2045 Holliday Drive, a City Engineering employee backed a City of Dubuque truck into ' claimant's vehicle. �' � � � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance PooL cc: Michael C. Van Nlilligen, City lVlanager I� Gus Psihoyos, City Eng6neer Robert Sigwarth � 6 , 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