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Claim by Dave Hubanks Copyrighted August 5, 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: David and Connie Cole for property damage, Dave Hubanks for vehicle damage, Mason Kobliska for vehicle damage, Robert Monthey for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo - ��'��;� �� ' CLAIiVI AGAINST THE CITY OF DUBUQUE, IOWA �� ; This written report constitutes your claim against the City of Dubuque, lowa. You should I complete this form in full and attach any additional information that supports your claim. ; The Claim rnust be filed with the City Clerk at City Hall, 50 W. 13t" St., Dubuque, IA 52001. It will then be referred b the Cit C y ouncil to the a ro riate de artment for inv Y pp p p estigatoon. Once 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 REPRESENTATIQN TO YOU ;� AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. • ,� �! 1. Name of Claimant: � ��-'�' �� ,/�J�i ��' � 'i I; 2. Address: � �� f��,� � � �; �, City: � �C��.t,.�,.�. II State: r��'�4- Zip: �'��;� �; 3. Tele hone Number: � �✓ �- � i� p .�°� 3 ��' �,� � � �� 4. Date of Incident: '�i �'�2� - �,.�� j � — � 5. Time of Incident: ��°/5` �"� !6. Location of Incident (Be specific): _ � � ��-r!�r.�r�� y �r �.�- I� u' �� 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAIVIAGE. (Give I full details upon which you base your claim. If a City err�ployee was involved, give the 1 �employee's name.) � � ��'t`�-� 1�� `i� �e �l�3�� d�'�-��^ %��^��1'`.�� ,� �� (J`a�� 8. What were weather conditions like? �/��;,� 9. Give narne and address of aroy witnesses: �� - �� l�� .�� 10. Did police investigate? (If so, give names of officers.) � �� 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). �� ; � � � ; � � 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.) ;i � (� I; � � �� . � C� d'� 9�' � i �b`" �� i��-�'. �r��r' r�� ii ,; � 13. What other damages do you claim, if any?� ,�� , � ��i 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.) "'; �; i �1 ;' ; ; 15. What amount do you claim from the City of Dubuque? , e ;; ��..�� 'a ��u' ��e�� e�� ;, Ls�:.�.t� �i ,� 16. Why do you claim the City of Dubuque is responsible? � p ''� `� t� �' C� ; i i 17. Have you made any claim against anyone else for clamages as a result of this incident? ' � (If yes, give name and address.) � � � 1 � � ' 18. !f the answer to Question 17 is yes, have you received any payment from that source, � �and if so, in what amount? � j� li � � �i � a Dated at e�ab�q�aP, l��raa #his '�.�day of_ �� , 2� I � �� u (Signature) � � . �-�" o � t �� `�� (Print Name) �� ..� � � � � �" �� a ' � � � � � r.�� „ ' �, �` � � N (Rev. 5/18) . � � � ,1 �- E � � x � 6 � , i �� Confidential �� G, This communication and any attachments may contain inforrrtation 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 irramediately by telephone at (563)-589-4120 of � your receipt of these items and destroy the communication and any attachments immediately. Further disclosure of this inforrr�ation may violate state and federal jj restrictions. Confidential information may include the following: I i� 1) Social Security Number(s) �i 2) Medical/Health lnformation 3) Personnel/Disciplinary Information 'r, 4) Bank Account Information � 5) Financiallnformation ,�� 6) Credit Card Numbers j � � 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 and indicate the t e of . . . Yp 'i information that is included. i ; � �� ? � S� , hereby certify that the attached documents h include the following protected information: � ; , Social Security Number(s) Bank Account Information i i� Medical/Health Information Financial Information � ,� , Personnel/Disciplinary Information Credit Card Number(s) � I understand that this information may be distributed within the City organization or to agents of the City for processing and I hereby authorize the City to act accordingly taking all precautions to protect my information from unnecessary distribution. _�, � ��,� � 2 � Signature Date � i� . � � � � Copyrighted August 5, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: David and Connie Coleforpropertydamage; Dave Hubanks for vehicle damage; Mason Kobliska for vehicle damage; Robert Montheyforvehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Cole Claim Supporting Documentation Hubanks Claim Supporting Documentation Kobliska Claim Supporting Documentation Monthey Claim Supporting Documentation THE CITY CaF T� LTE MEMORANDUM Masterpiece on the 1Vlississippz � TRACEY STECKLEIN �� PARALEGAL To: Mayor Roy D. Buol and Members of the City Council � i DAT�: July 28, 2019 RE: Claim Against the City of Dubuque by Dave Hubanks _ ; - - , ��, Claimant Date of Clairra Date of Loss Nature of Claim � ; � Dave Hubanks 07/26/19 07/25/19 Vehicle Damage � This is a claim in which claimant afleges that as a City employee was moving grass at AY McDonald Park, a rock flew from the lawn mower and struck and damaged the driver's side back door of his vehicle. �, � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. cc: Michael G. Van Milligen, City Manager Stephen Fehsal, Park Manager Dave Hubanks ' 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,vc (563)583-1040/EMai� tsteckle@cityofdubuque.org