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Claim by Alec Lee Benson Copyrighted September 16, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUM MARY: Ronald Bahr for vehicle damage, Alec Lee Benson for vehicle damage, Michael Dorr for vehicle damage, Keaton Kephartforvehicle damage, Michael and Jill Pankowfor property damage, Christy Reed for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Bahr Claim Supporting Documentation Benson Claim Supporting Documentation Dorr Claim Supporting Documentation Kephart Claim Supporting Documentation PankowClaim Supporting Documentation Reed Claim Supporting Documentation �� ,. �t� `� a C�AIti� AG�e1NST THE �ITY OF DUBU(�11E, lQWA � �"` � ; r 1'his wriften report constitutes your claim against the City of aubuque, Ic�wa. Yo�a shc�utd � cc�mplete this fc�rm in full and attach any �dtiitianal ir�formation that s�ppt�rks your clairn. i i The Claim must be filed wi�h the City Clerk at City Hall, 50 W. 13�" St., C?ubuque, lA 5�001. It ;� will then be referred by the City Council ta the appropriate department for investigation. � 4nce that investigati�n is campleted, a report and recammendatic�n will be ��bmitted to th� ' City Cc�ur�eil. You will be provided with a cc►py c�f�hat report and recommendation, THE FINAL DEC[S1C}N C?N ALL C�AIMS IS MADE �Y THE C1TY CC7UNG1�. NC} EMPLC3YEE C}F ; TH� CITY OF DUBUQUE HAS THE AUTHC}R�TY TtJ MAKE ANY FtEPRESENTATION TC? YC}U � A� TC} WHETHER YC}UR C�A�1M WILL Qi�WI�� NQT BE PAIC}. '� 1. Name of Cla6mant: ,�� , ��5c�r'� 2. Address: � e� r � � � � �� ..:�,,,�� . c�ty: �... st�t�: ��'� z��: �l � .�..�...� . _— �, 3. Telephone Number: �'�+�a�� l�- ��_ , , la 4. C}ate af Inciden�. �� 5. Time af Incident: � � �►!� �;; , 6. Location of Inciden� �Be specific}: �+� �� '�� l0 �� /� �]i �l �� ?. DESCRIBE ACGIDENT t)R 4CCURRENCE THAT CAUSE� fNJURY t}R aAMAGE. {Give s full details upon which you base your claim. If a City empFoyee was involved, give the ' emrplaye�'s name.} � o � 4 �� r� �� v � �� b�� ' cC+� n� � ��,� ��' � � �dl� � �r��-� br��r�s �r�., � s;��'�� ., ��, �. What were weather conditians like? �.,�� 9. Giv� name and address af any witnesses: � �''��' C,o�./� � a '10. Did police investigate? {If so, give nat�es of officers.} ; a � 11. Was anyone inj�ar�d? (If so, give names, addresses, and extent of injuries). � � � � � � � � i � l 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.) � ,: �r ' �L P e� � ;cC�- f C e. �r , I,`; ��r �1��r �'� �i�?��►��r, Q�us� vhC� a�► f?'��r, 'i; m = � I; 13. What other damages do you claim, if any? ��1a- '�j , , i , � i 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; .IvO i � , , 15.��Wh�at ount do you claim from the City of Dubuque? '„ �i 16. Why do you claim the City of Dubuque is resp�nsibl ? i; � er' Je 9 So eo�. �QV�er bA5 �s ¢� 6 e !� a�� P 17. Have you made any claim against anyone else for damages as a result of this incident?b��F , �� ,� (I�yes, give name anci acidress.) '`�,/• � �� ; 18. If the answer to Question 17 is yes, have you received any payment frorn that source, � and if so, in what amount? � � i _ ,; , 'I Dateci at Dubuque, lowa this � day of � iM ��_, 2��. � ,� � � , (Signature) � � /„�<- L��- !1��/� , (Print Name) C') � `�``' r��r � � � � C� `'� �� T� � �'"' � (Rev. 5/18) �► � m � �. � � � � � � � i 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 is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of li your receipt of these ;i#ems and destroy the communication and any attachments '� immediately. Further dl'sclosure of this information may violate state and federal I! res#rictions. � ,I Confidential information may include the following: �� '�I 1) Social Security Number(s) 2) Medical/Health Information �: 3) Personnel/Disciplinary Information I�� 4) Bank Account Information 'il 5) Financiallnformation �i 6) Credit Card Numbers �� '�,� � If any documentation you desire to submit to the City of Dubuque contains any of the items above 111 this cover sheet must be attached directly to the confidential information and indicate the type of �I information that is included. II ��i � d I l�-� �4 hereb certif that the attached documents � , , Y Y include the following protected information: i Social Security Number(s) Bank Account Information j Medical/Health Information Financial Information I� � Personnel/Disciplinary Information Credit Card Number(s) I� � 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 accordingiy taking ail precautions to p protect my information from unnecessary distribution. q/�/�s Signature Date � Copyrighted September 16, 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: Ronald Bahr for vehicle damage, Alec Lee Benson for vehicle damage, Michael Door for vehicle damage, Keaton Kephart for vehicle damage, Michael and Jill Pankowfor property damage, Christy Reed for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo Dubuque THE CITY OF � D B All•A�eeieaCity U E <<xn.��n.��..� ; ] �► � � MRste iece on the Mississi i zoo�•zoiz•zoi3 rP pp zoi�*zoi9 TRACEY STECKLEIN � PARALEGAL MEMO To: Mayor Roy D. Buol and Members of the City Council DATE: September 12, 2019 RE: Claim Against the City of Dubuque by Alec Lee Benson Claimant Date of Claim Date of Loss Nature of Claim Alec Lee Benson 09/11/19 09/05/19 Vehicle Damage This is a claim in which claimant alleges that his vehicle sustained damage on the passenger side from rocks and on the bumper from the sweeper brush when a City sweeper swept the alley in the 400 block of Lowell Street. This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager John Klostermann, Publlic Works Director Alec Lee Benson OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 30O MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563)583-4113/FAx (563)583-1040/EMa�� tsteckle@cityofdubuque.org