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Claim by Nick Hermsen Copyrighted May 6, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Konstantine Batonisashrili for vehicle damage; Nick Hermsen for vehicle damage; Kassandra Jacobs for vehicle damage; Carol McDonald for property damage, Aiman AI-Qady vs. City of Dubuque Housing Board of Appeals. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Claim by Konstantine Batonisashrili Supporting Documentation Claim by Nick Hermsen Supporting Documentation Claim by Kassandra Jacobs Supporting Documentation Claim by Carol and Charles McDonald Supporting Documentation S uit by Ai man AI-Qady S upporti ng Documentati on �� v � �'�� r �C�5 �..�� C�AIM AGAINST THE CITY QF DUBUQUE, ItJWA ��.{�, This writ�Eet� report constitutes your claim against fhe Cify of Dubuque, lowa. You shauld complete this farm in full and attach any additional information that supports your claim. The Claim must be filed with the City Clerk at City Nall, 50 W. �13th St., Dubuque, IA 520Q'(. It wi!( then be referred by the �ity Council �o the appropriate department fc�r investigation. Once that investigatian is comp(eted, a report and recammendation wi11 be submitted tr� fhe City Council. You wif! be provided wit� a copy of that report ar�d recommendatian. � i THE FlNAL DEGISIC}N ON A�L. GLAlMS !S MADE BY THE CITY COIJNCII.. NO EMPLQYEE OF THE CITY OF DUBUQUE HAS TNE AUTNQRITY T{� MAl�E ANY REPRESENTATI{�N Tt� YQU i E AS TC? WHETHER Y4UR CI.AIM WILL (�R W1�L N�T BE PAID. I ,I 1. Name of Claimant: �� 1 � � `� �a 2. Addr��e ��"� � `��'�� i u Gity: ��.�r __ 5tate: �� Z�p: �� 1 i; 3. Te�ephone Number: _ ��-�P�'��-' �-�� ;i � i A�. Date of Incidenf: _�� ,]� t�l� � , ;i 5. Time c�f Incident: �„�4•��' ;i 6. Location of lncident(Be specific}: �� (V��'��e�,� � '`P ' ' � �; � ; C T. DESCRIBE ACClDENT OR OCGURRENCE THAT CAUSED INJURY OR DAMAGE. (Giv� � futl details upon which you base yaur claim. If a City employee was invotved, give the � employee's name.} � �� ``�� '� � �� .� � � � � �.� �� f �� 8. Vlthat were weather condit�ons like? � _ ��`�� '�� 9. Give name arid address af any witnesses: �� '10. Did police investigate? (If so, give names af officers.} _��„�..n �� . � '1'I. Was anyone injured? (If so, give names, addresses, and extent of injuries}. � � �� II 12. Was any damage done to property? (If so, describe property and the extenfi of damages. Attach estimates of damages or describe basis for ascertaining extent of � � damage.) ' �..,��.�� v �'v1� �.�� Sc��— ''I � � � � 13. What other damages do you claim, if any? �� '; ;� 14. Have you been compensa�ed for any part or all of your claim by any insurance � company? (if so, give name and address of insurance company and amount paid.) + `� i� N� ; � 15. W at m unt d you claim from the City of Dubuque? ��,�� i ;�� 16 hy do you claim the Gity of Dubuque i. res onsibl ? \ � �I �� ✓ � �.�d.f` � �C � o�- � ��.� �r9.�°��--� ; j, �i I �i7. Have you made any claim against anyone eise for damages as a result of this incident? � (If y�, give name and address.) � � 18. If the answer to Question 17 is yes, have you received any payment from that source, � and if so, in what amount? u �d� � ; i � �_� � �ated at Dubuque, lowa this � day �f -�s� . , 2Q,�,. s� g .--� I � (Signature) _�� (�� .� (Print IV�rr�� _.�:-e � �� '' � `�-"-', �_ `-�'� �'' �';*�, � i•", i �� CI) "�' y""" € l(:! g_ _�, �- � �� , �..�? y } 'i �._. (Rev. 5118) � c� d Copyrighted May 6, 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: Konstantine Batonisashrili for vehicle damage, Nick Hermsen for vehicle damage, Kassandra Jacobs for vehicle damage, Carol McDonald for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo -------—-- ___- � ____ ___ __- _ _ _ _ _ � THE CITY OF � �I-� E MEMORANDLJM a Masterpzece on t1�e Mississzp�i � � / TRACEY STECKLEIN � PARALEGAL 1 I�� i7 To: Mayor Roy D. Buol and � Members of the City Council � � I, DATE: April 25, 2019 � !i RE: Claim Against the City of Dubuque by Nick Hermsen { Claimant Date of Claim Da#e of Loss IVature of Claim ,{ Nick Herrnsen 04/25/19 03/18/19 Vehicle Damage i This is a claim in which claimant alleges that his vehicle which was parked near 2474 Wilbricht Lane was struck by a City of Dubuque Leisure Services vehicle. � This claim has been r f � e erred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager � Marie Ware, Leisure Services Manager �� Nick Hermsen � 6 � � � �, OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/F,4x (563)583-1040/EMa�� tsteckle@cityofdubuque.org