Claim by Mason Kobliska 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
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA �. }�Ic�1-a,s-,v,�,,,n,�
This written report constitutes your claim against the City of Dubuque, lowa. You should
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. 13th 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 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 REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: Mason Kobliska
2. AflC�l'@SS: 1959 Lincoln Ave
City: Dubuque State: �0"'a Zip; 52001
3. Telephone Nurnber: 1-563-495-6309
4. Date of Incident: �une 30, 2019
5. Time of Incident: Approximately 6:00 p.m.
6. Location of Incident (Be specific): 1900 Block of Lincoln Ave
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.)
A city of Dubuque Tree had a large portion break off during the storm and landed on the top of my 2004 Audi A4 Quattro I recently purchased. The trunk,rear bumper,front and rear
corner panel,drivers side doors,top of vehicle and hood of car are dented in and heavily scratched due to the tree branch falling.We made a police report and they took photographs
o e ree an amage. a so ave p o ograp s o e car e ore an a er e amage w ic i ave a ac e ere o.
8. What were weather conditions like? Storming
Dawn Hinzman,1959 Lincoln Ave.,Dubuque,IA 52001
Joyce Dolter,1966 Lincoln Ave.,Dubuque,IA 52001
9. Give name and address of any witnesses: Chariie Menadue,1958 Lincoln Ave.,Dubuque,IA 52001
10. Did police investigate? (If so, give names of officers.)
Yes,I am unsure of the officer's name but the case number is 2019-004889.
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
N o.
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.)
Yes,the entire car is dented and scratched.I have attached photographs of before and after the tree falling and an estimate of the body damage caused by the tree.
13. What other damages do you claim, if any? None.
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.)
No.
15. What amount do you claim from the City of Dubuque?
The car is totaled so i would like the fair book value of the vehicle.
16. Why do you claim the City of Dubuque is responsible?
The tree that fell is owned by the City of Dubuque.Also,when you look at the remaining tree you can see that the tree itself is rotting which is a safety issue.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name ancl address.)
No.
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
N/A
Dated at Dubuque, lowa this day of July 20�.
,
(Signature)
Mason Kobliska (Print Name) �
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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 here�iy 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 immediately by telephone at (563)-589-4120 of
your receipt of these 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:
1) Social Security Number(s)
2) Medical/Health Information
3) Personnel/Disciplinary Information
4) Bank Account Information
5) Financiallnformation
6) Credit Card Numbers
If any documentation you desire to submit to the City of Dubuque contains any of the items above
this caver sheet must be attached directly to the confidential information and indicate the type of
information that is included.
I, ���`� C;`��=��` �`����� , hereby certify that the attached documents
include the following protected information:
Social Securifiy Number(s) Bank Account Information
MedicallHealth 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 her�by authorize the City to act accordingly taking al! precautions to
protect my information from unnecessa�y distribution.
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Signature Date
,
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
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TH'E CITY OF
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TRACEY STECKLEIN � I�14
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To: Mayor Roy D. Buol and �
Members of the City Council �I
DATe: July 15, 2019 � � �
RE: Claim Against the City of Dubuque by Mason Kobliska
Glaimant Date of Claim Date of Loss Na#ure of Claim
Mason Kobiiska 07/15/19 06/30/19 Vehicle Damage
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This is a claim in which claimant alleges that his parked vehicle in the 1900 block of
Lincoln Avenue was damaged after being struck by a Cifiy tree during a storm on 06/30/19.
This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa
Communities Assurance Pool.
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cc: Michael C. Van Milligen, City Manager ��,
Steve Fehsal, Park Division Manager '�
Masan Kobliska �;
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OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA �
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 g
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