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Claim by Brian Feldman Copyrighted August 19, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Susan Beckman for property damage, Mike and Jeanne Duggan for property damage, Brian Feldman for property damage, Bill and Kathy Miller for property damage; Tiffany Anderson vs. City of Dubuque et al. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Claim by Susan Beckman Supporting Documentation Claim by Mike and Jeanne Duggan Supporting Documentation Claim by Brian Feldman Supporting Documentation Claim by Bill and Kathy Miller Supporting Documentation Suit by Tffany Anderson vs. City of Dubuque, et al. Supporting Documentation � � - .� V�'�� {� .�5�-1-�.;,�� CLAIM AGAINST THE CITY OF DUBUQUE, IOWA � , � , This written report constitutes your claim against the City of Dubuque, lowa. You should ! co�nplete this form in fuli 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 subrnitted to the '�i City Council. You will be provided with a copy of that report and recommendation. '� 'ii 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. . !' a � � i ;� 1. Narne of Claimant: r '�''1G�Nr `�—�,��c�e� � i`� � 2. Address: � � � ° � w � Clt)/: ��_�� 1 �„�„ Stat@ �C�(..�.;1� �Ip: �� i 3. � Telephone Number: ��"� �� - ��.��. � r ;i 4. Date of Incident: � °�-' ` � �- ' � � � 5. Time of Incident: �AY� � � i �� `� � � � • e 6. Location of Incident (Be specific): �� M� �-��Q..�t �� , � �� , ;� � 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Giye �� full details upon which you base your claim. If a City employee was involved, give th�� employee's name.) �.-�—�� W��'� ��,�� N 1� .�r � �n c�. `��C��' ,.�� G��-�� n, ��.� � � 1� �� I �"��- � ° � -�-s�, ° �,� � L ��- c� �`t �� \�R y�� 3 � 8. What were weather conditions like? `�.� ��,,��f � - 9. Give name and address of any witnesses: ��. � 10. Did police investigate? (If so, give names of officers.) e c ��,�. �� "� �i� llt�'�" �r�1� �. ("��'3�"�" 5��.�. i�" R�Y'i�� P�``� � 11. Was anyone injured? (If so, give names, addresses, and extenfi of injuries). � � � � � � � �i ! 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� �tvr��i�� { , ;i Y , �i 13. What other darnages do you claim, if any? (� � � j � i �� i 14. Have you been compensated for any part or all of your claim by any insurance ;1 company? (If so, give name and address of insurance company and amount paid.) �� i; ,; 15. What amount do you claim from the City of Dubuque? c f; �� ah� ��.c� �� !� 16. Wh�y d�o' you cl�aim t�he�City of Dubuque is responsible? �';; R III I� II�I 17. Have you made any �I�irt� �g�ir��t a�yon� �9�e f�r darnage� a� a r��ul��f#hi� incident? � (If yes, give name and address.) � � � i ,, 18. If the answer to Question 17 is yes, have you received any payment from that source, � and if so, in what amount? � � j i i �! i,i Dat�d a# D�ab��qu�, I�wa this �� day of__�.c�� , 20�. `� f w A . � (Signature) '�{"1C�� .�c��1C.�� :� � (Print Name) .:�`�-� � � `�� - c� � � ;,,� � g � �� d :� � � � � (ReV. 5/18) �'' --h �`' ��°' m . c�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, and that any review, disclosure, dissemination, distribution or copying of its contents j 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 � y immediately. Further disclosure of this information may violate state and federal � restrictions. ,i a � � Confidential information may include the following: ��y i 1) Social Security Number(s) ,� 2) Medical/Health Inf�rmatic�n � a 3) Personnel/Disciplinary Information �; 4) Bank Account Information ; 5) Financiallnformation i; 6) Credit Card Numbers ;;: f'; 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 type of 'I information that is included. � � � , i� �� , hereby certify that the attached documents include the following protected information: !� �l !i Social Security Number(s) Bank Account Information ,� �i � 8 Medical/Health Information Financial Information � ' � Personnel/Discipfinary Information Credit Gard Number(s) �� I understand that this information may be di�tributed within thP ��ty ��ng�� ±� 2�0�� f�� City for processing and I hereby authorize the City to act accordingly taking all precautions to protect my information from unnecessary distribution. �3��C�''>'► � I _ I�' , � � Signature Date . � � � � � � � Copyrighted August 19, 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: Susan Beckman for property damage, Mike and Jeanne Duggan for property damage, Brian Feldman for property damage, Bill and Kathy Miller for property damage SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo THE CITY QF �'UB E MEMORANDUM Masterpiece an the Mississippi TRACEY STECKLEIN PARALEGAL To: Mayor Roy D. Buol and ,� Members of the City Council ' � DATE: August 15, 2019 j; u � RE: Clairr� Against the City of Dubuque by Brian Feldman � �� Cla�rnant Date of Claim Dat� of Loss Nature of Ciaim i i Brian Feldman 08/14/19 08/12/19 Property Damage � I� This is a claim in which daimant alleges that a City of Dubuque fire truck struck a row of � mailboxes while attempting to back out of Heidi Court. �� This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa h Communities Assurance Pool. � cc: Michael C. Van Milligen, City Manager Rick Steines, Fire Chief Brian Feldman � � N � � 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