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
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�LA[M A�AINST THE �ITY t�F DUBUQUE, ICJWA► �� `
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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. �
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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. �
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'1 n N�m+e of�laiman�o ��..c� �� �- ��� :�
2. Add�ess: ���`E� ��,.�'�
City� �,,���,� State. ��' �ip: � ;
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3. Telephone N�amber: ��� ..���� �t� ;
4. D�te of Incident: '� I� ��� � �� .. A � �� �, �t� �
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5, Tim� of lncident: �,�.c. �'"�`� �� � k��. . I�.
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6. Locat�o� o# Incident {Be specifi�}: —���.�.- �1c�--� `�' �t,.e.�" ������- �
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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.) �
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�. What were weather conditions like?
9. Gave name and address. of �ny witnesses: ������,�� �� k�`cr5.�, �1�� �' ���r ��i �
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� ��+`d`i rt �"c��+.�► r Ct��c"�`�'�r" �!5�. ���"'��'�'t��h�
10. Did police investigat�? {[f so, give names of officers.} 4
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11. Was anyone injured? {If so, give r►ames, addresses, and extent of injuries}.
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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.} �
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13. What ather damages dc� yc�u claim, �f any? � �`�';� °"�'"""�1�,���(�� �`� �
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�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.) ?
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�15, �t1/hat ama�ant dc� you cla"m fram the City of Dubuq.ue? ,,, �,, � �' ```` p ;
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16. Why da you claim the City of C}ubuque is res�on ible? a'
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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.) �
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�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'? �
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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�
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Confidential inf�rmatian may include the following: ';
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1) Sacial Security Number(s} '
2} (V�edicallHealth lnformatior� � � � � �
3) Persanne�lDis�iplinary Infc�rmation a
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4} Bank Account Infarma�ion ';
5) Financiallnformation �
6) Gredit Card Numbers �
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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. � � �
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I, �` �� , hereby certifiy that the attach�� dacum�nts �
include the fo��wing protected information:
Social Securifiy Number�s) Bank Accc�unt Information '';!
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�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.
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