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Claim by Garry Redman Copyrighted J une 3, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUM MARY: Daniel Jacobs for vehicle damage, Patrick Konzen for property damage, Garry Redman for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Claim by Daniel Jacobs Supporting Documentation Claim by Patrick Konzen Supporting Documentation Claim by Garry Redman Supporting Documentation , . ��� �„�. tc� �� �LA[M A�AINST THE �ITY t�F DUBUQUE, ICJWA► �� ` � . ��'�� �-��� Th9s written report consfitutes your ciaim against the Ci�y of Dubuque, lowa. You shau�d complete this form in full and atfach any additianal information that supparks your claim. The Claim rnust b� fiied v�ith the Cify Clerk at City Hall, 50 Wd 't3t�' Staa �tubuc�ue, IA 5200'[, lt will fihen be referred �ay t�e City Council to the appropriat� department for inv�stigation. t�nce that investigation is completed, a repor� and recommendation w.ill be submitted ta the �ify Council. Yau will be pravided with a �opy of that report and recommendation. � 3 THE FINAL DEGISICJN ON A�L CLAIMS 1S MADE BY THE CITIf �OUNCIL: N4 EMPL:OYEE UF ir THE CITY O� DUBUQUE HAS THE AUTNORITY TQ MAKE ANY REPRESENTATION TO YC}U k A� T�3 WH�TH�R YC�UR CLAIM 1N1�.� OR�IIL.L �IOT �E PAID. � , '1 n N�m+e of�laiman�o ��..c� �� �- ��� :� 2. Add�ess: ���`E� ��,.�'� City� �,,���,� State. ��' �ip: � ; � —�� � � � 3. Telephone N�amber: ��� ..���� �t� ; 4. D�te of Incident: '� I� ��� � �� .. A � �� �, �t� � � � '' � 5, Tim� of lncident: �,�.c. �'"�`� �� � k��. . I�. � _ , : � 6. Locat�o� o# Incident {Be specifi�}: —���.�.- �1c�--� `�' �t,.e.�" ������- � I �. •-�-� � � �. �. � '�i _ � 7. DESCRIBE ACCIDENT C?R C}CCURRENCE THAT CAEJSED INJURY t3R DAI�AGE, �Give full details upon which yt�u base your clairt�. If a City employee was involved, give th� � erir�pl4y�e's n�rt�e.) � � C ����,� �. ���' � �3 � �~ ����`��� � � �Y�. � .s�F' r� i 9 �� �7�. t�f'^�. � � , t` �� �a.a� �� �°'� ����'d2�j �� � � -s�. �t.��` e�?� °�-�"� �. What were weather conditions like? 9. Gave name and address. of �ny witnesses: ������,�� �� k�`cr5.�, �1�� �' ���r ��i � � � ��+`d`i rt �"c��+.�► r Ct��c"�`�'�r" �!5�. ���"'��'�'t��h� 10. Did police investigat�? {[f so, give names of officers.} 4 �� �-��� • 11. Was anyone injured? {If so, give r►ames, addresses, and extent of injuries}. �� � 12. Was any dam�ge done #c� praperty? {tf so, describe praper�y and the extent af � damages. Attach estimates of damages or describe basis for ascertaining extent of ` damage.} � i: i �"�'c,�. �«��°— t�� S `�' t�� � � � �'��l�e a .s�� �c��� �; � � i�t �t. �S��J�-� � a � �� � a.�.��` �.i� �?��S 1�' � b�t5��, n.��"` � a�3 ��,�!�'�� ,, 13. What ather damages dc� yc�u claim, �f any? � �`�';� °"�'"""�1�,���(�� �`� � �;r 9��'r- �. � � . � � �- �.�.I��`� B � � �a. � �t�!.� �`�'. �^f'�. ��'s �f t'��..� �9 ��"�` �C.�,���E'� �� `�' d.+� C�'�i � � , �i4. Hav� you be�n ��rr�p�nsat�d far �ny �art oa� all of ya�r c�aim by any ins�rar�ce company? {(f so, give name and addr�ss of insurance campany and amount paid.) ? , � � ' , , ..�-��� � �15, �t1/hat ama�ant dc� you cla"m fram the City of Dubuq.ue? ,,, �,, � �' ```` p ; a � .�P✓� ' � �t � o �d'^ `!' }-�„�,r�7 `i�� + ( � X�� ( y � ,�. t..�.,�,�,.,,...,.,,'. r 16. Why da you claim the City of C}ubuque is res�on ible? a' �.� �� � �. �C � �� � i� 1To I-�av� �o� �a�[� ��y �1��� a�asnst aa��c��e �ls� f�ar d�mages a� � re�s�lfi of�hds ie����e�t?, 4 {tf yes, give name and address.) � � � � �18. If the answer tc� Q�aestion °17 �s yes, have yr�u received any payment fram that sc�urc�, � and if so, in what amc,unt'? � � � A D�#Ad �t ��!���que, lo�a �hi� ��� �f �.,�- , 20 � �— � q � � {�I�CI��I.lC�} � � � f7�.1".�� ,�°�f'�'Lt��'i ���,.�,�� � �„�,� �PCft�� ��171t'� �' cs � �� � � � � � � �� t,� C� � � � � � � �� � c� � -� ,,� , � (�e�r. 5118) . � r a � � ct� � � � � � Confidentia� ' This communicatic�n and any atfachments may contain informa�ion whict� 6s canfiderttia! � 1 and privileged by (aw and is for fihe use of #he d�signated recipient. If you are r�o� tne infiended recipient, you are hereby notified that yc�u have receiv�d this com'mtanication in error, and that any review, disclasure, dissem�natiort, disfiribution or copying of its contents � is prohibited. Please notify City af Dubuque immediafely by tetephone at (563}-589-4'1�0 of � your receipt af these items and destrcry the communication and any attachments j; immediately. Further disclosure of this informataon may v�olate stafie and federa! � restrictians. � i� � i; G Confidential inf�rmatian may include the following: '; '�� , 1) Sacial Security Number(s} ' 2} (V�edicallHealth lnformatior� � � � � � 3) Persanne�lDis�iplinary Infc�rmation a �� 4} Bank Account Infarma�ion '; 5) Financiallnformation � 6) Gredit Card Numbers � � If any documentation you desire to submit t� the City of Dubuque contains any of the items above ';; this cover sheet musfi be att�ched dir�ctly to the confidential infarmati�r� ar�d indicate the type of ir�formation that is inclu�ed. � � � 3 � I, �` �� , hereby certifiy that the attach�� dacum�nts � include the fo��wing protected information: Social Securifiy Number�s) Bank Accc�unt Information '';! � �Medical/Nealth lnformatian Financial Informatian Personnel/Qisciplir�ary Information Credit Card Number(s} 1 undersfiand that fihis ir�farmatior� may be distributed wit�in �he City organi�ation or ta ag�nts af the City far proces�ing and I her�by authorize the City to act acc�rdingly taking all prec�utions ta � protect my information from unnecessary distribution. ��` ��'�`( � ` � ►gnatu D�te �