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Claim by Lily Michele Reed Copyrighted July 1, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Lilly Michele Reed for property damage; Marc Zugenbuehler for vehicle damage; Frantz Family Properties, LLC / CHS Forwards, LLC vs. City of Dubuque, et al. for conveyance of real property. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Reed Claim Supporting Documentation Zugenbuehler Claim Supporting Documentation Fran�/ CHS Forwards vs. City of Dubuque, et al. Supporting Documentation _ V a�.� CLAIM AGAINST THE CITY OF DUBUQUE, IOWA F+� ��. ' ��b�ic v����.5 This written report constitutes your claim against the City of Dubuque, lowa. You s ould 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. 13t" 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 fio 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. 1. Name of Claimant: �.t�u t�11 C � . �J- .� 2. Address: �to0� Lau.��da.�e, S�C`�, '� �� 520b �o�y: U�U�� Sta�e: ..LA p: ( 3. Telephone Number: 5 �i3" 5 0�rc3JZ$ - - - - - � - - - - - � - 4. Date of Incident: �tlLt1� Z .�q, 5. Time of Incident: G� ��Y�►. �@,. �f1 � l,a�molo�e, 6. Location of Incident (Be specific): cwcve o� s�dewat� �ro �h�, lt� � h�use�• ��1R,�fi,, 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.): � k�ce engin� d�cove �pas�- o� h�orne on �° ���• �n b j�1 � � �Dv�nd ovx s�dewc��l cwcb cro�,�, a�► �rwcne,d wp . �s e �rac�s ax�l r�,�s �v�dc.n'cc�.:�o�n t a�n �e s� 1� ti� �ho�os t�.t�n. . 8. What were weather conditions like? �11��f11C�► ' 9. Give name and address of any witnesses: �� 10. Did police investigate? If so, �iv� e names of officers.) :�, eo�►�ec� �he non-e�1E^!' � �+he a�c a:ZS �m on �(Z� �m. o�cieax Ca.t'be�r a�cctved, � tox. �n:�o�. t�� h S tic a�<�v� 0�l11 '�fl�, � ��eS � . S� i-� v�c�,,5 0. �f U.CJt� oM, �i,(` S'��ov� ,�``��b 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). NO• 12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of damaq,es or describe basis for ascertaining extent of damage.) � �j�S• �Cte SC�Ub.X�S o'c S l�.vJ0.��, U.�Ce C'C0.C��► 0� �X� u.Q u�1�n sac�, do�ma�e, �, -�a, �,u�'b• �o.�mo.� �s s�ocri,a,,,,�rc,� ��5�• c9.z� e�nve.��o.k�oc� ���k�, �e� � ` ��20 �- �5�� 1h ct�o��c o.z�, �c�o� c�sts. 13. What other damages do you claim, if any? �'0'�L. 14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give name and address of insurance company and amount paid.) �0 • 15 What amo t do ou cla` from the City of Dubu`ue? . • •� — - - - - - Ce��.�°�`o�S. - 16. Wh do you c 'm the Ci y of D b ue is responsible? C}�1C�C � 'C S � 01 ' �C �.� C�C�e- p aS ouz r�orn�, o� a 2a. t�e, ' c� c �,�ce� o.e� s v�e�ce '�. 17. Have you made any claim against an one else for damages as a result of this incident? ,(I#�yes, give name and address.) !J 0 • 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��l�Q. , 20 �q . _.1,,� � �Q �": ��� -{�-G'' � �� ,- � � ; � `-� % rTl V�� (Signature) (" �, � � =� �I� �. _,_. � . � � C.:� LI� �e(� (Print Name) � � See ���:�nQ.� �c,'�e.s . ��e�x o�► � ��;�o�n �t �o�. Q�'�s a� db�wrnax�,'c�'���n (Rev. 5/18) (�S Ul�" � � ��'��V�-U O�, CCS..� ` �R ��2` Q-� �i�J�,,`, �Com S'�'�� � � c�ha s�ad '�o C��� �r�� ��ceC,�� v�� �v� ��s�o�s . � � Confidential This communication and any attachments may contain information 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, �nd 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 your receipt of fihese items and destroy the communication and any attachments immediately. Further disclosure of this information may violate state and federal restrictions. Confidential information may include the following: . + �_I.F4`i} '4Jd-�,f'�!t� 3,d ��F7�'.� 1) Social Security Number(s) ; 2) Medical/Health Information ,���A;{,�> fit.'�j,�=7.��,�,{F`,tj' ,��F�31�' 3) Personnel/Disciplinary Information 4) �B�n�-Accourit Infnrmation F-�,�. ,,��� �r � `�� 5)� F�nar��i`al Information f'3��•� ��� �•� � :r 6) Credit Card Numbers �;t�-t�,�0a �*,.�a .� , �. ; ,� , ( �.✓ p •+M 1 e.:z S..�l.,f _.l��.i�,, `k,.,Iy),+ ' �f any documentation you desire to submit to t�ie �,ty�afq pubuq�e conta¢r�s any of the items abo�re � - this cover sheet must be attached directly to the �confiident�al�ir�for�a�ion'and indicate the type of information that is included. q. f-, �.r, ��•_,p�^ ����"��o � h fl:j: �61 �...1 Y�.,.�' ,e i i..l L�1,�..�„f i�'�Ria.`,9/�ZAI�,.� � ��,; r b � �}+y t � ,.a , .� .. 'v� . �),,t -�..` � + e � .1„'.j �..; ��tJx!IL�`1 �� ��d 1,�� )r t. P ,�+� �5f, ��i a'�.,�..� ,'f.le,� f'(,! �,.� '� .f�„. I, � , hereby certify that the attached documents include t following protected information: Social Security Number(s) Bank Account Information ;�n' i ���a �� l'�:�� �'�IVl�dicallFt��alth`�IM�'o�r�iat�dr�"� ��,,�'i�� ��y''�'�,f� ��ri�,'��i�l In"�f�Fr�na�ibn , ,s I �,,,��:�Y� �`�'�� �`��'���.��°�q �"3�;. AJ ��.,�1����`�y 1�'��� ��`�.,����`�� ���.,19.�s�s���..�'����1},� ;�t,�c� �'�`�:��lc��t� � ;; �'ersonnel/Disciplinary� nformation t Credit Card Number(s) i����i.�i 'v +#��l.g�Sj�#(� '�t �° +� Ci" ii r-: ��� �e� e/'` tS��+ . •. i u � -,► �� J � i�� ..�,.#; ..�.,i 1��..�.., �t'��t;:�.�•:1a�"?I� 1? I understanc� th�t this information may be distributec� within the City organization or tc� agents of the City for processing and I hereby �uthorize th#e�;Ci,t,�a to act accordingly taking all precautions to protect my information from unnecessary distri�`uti�ir�.` � r"i;t�i y ` ' � ll� ��#���� ��,�.� ��- �� �:, g, �.���, �:�: ; �� � s e�R'i�l,r�1{�� q ..l, ( �.{�t l` /.d1�.i� pj.#. )1l�r,. ..� �._�,..�>.1�� d a�'jY� /t^p r�+ } . �j n�rti .,� �.; 'q � � �_' c.� f y- � `�`r '!z' w�,�� 4�(~�1I� �I Ila�lU�• , 8+1. U' J � {dS. L��Y,R ..- +��6t�� . �.,, �7i'� , �,g y r�. � r1 4`g .a � ,r ` �� } � °� ', � 'i °�; ' 4,.� r�, r r s:;°�. a''•,�• ,s`�� '� ;�'ti�J , ..j��: :" i:'���..3.��r�'����' �'��!,�f;f;' i�f,i..�°.� `�t`��h���.11�'� �;�1�� �.� ,' s:;.���:t�.j i��,':1'i�' `��`� ^'$t�,`� ��f• i�-�r"i °y/� �f..! �*w y'� l�E+ �/ 'r '1 r r ����t t�t 1��' r�? �Y�� i i,ij 1!` tl� s.l � 1 r. + i d«n....-'i���, A,� d„l J�� al .��'w_.!.kI ft:�� � a,[�:d�.� �� k e :t:: t ��'�� �e . � } � '� 'I' r i;� � Sr ( 'R°K���:`J '�°'�jd S-.� �+F,��L ��� ar , �iJ:.+L�� �ji�r,.�,� �,,;.,�'�f P }'�'} a } ' tJ�,'� Copyrighted July 1, 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: Lily Michele Reed for property damage, Marc Zugenbuehler for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo THE CITY QF �-B E MEMORANDUM � � Masterpiece on the Mississijapi � � d � TRACEY STECKLEIN � � PARALEGAL � i , 1 i To: Mayor Roy D. Buol and ; Members of the City Council i 'i DATE: June 25, 2019 � t � RE: Claim Against the City of Dubuque by Lily Michele Reed �� i � ,1 Claiman# Date of Claim Date of Loss Nature of Claim � i I� Lily Michele Reed 06/25/19 06/20/19 Property Damage ;! � �� This is a claim in which claimant alleges that claimant's sidewalk and curb located at 1608 � Lawndale Street was damaged after a City of Dubuque fire truck drove over it. i� I This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa r Communities Assurance PooL 1 cc: Michael C. Van Milligen, City Manager � Rick Steines, Fire Chief John Klostermann, Public Works Director Lily Michele Reed � � � � OFFICE OF THE CITY ATTORNEY DUBUQUE, (OWA � 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 � �