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Claim by Michael Dorr 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 ��.\ M �('c� rn . �� CLAIM AGAINST THE CITY OF DUBUQUE, IOWA j. ��Q m� 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. 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 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: �� 1 C U��--�� ( ] �{� �.. � 2. Address: �� f G! `��1 C` �� r`J / - � , � , �� . City: C�.�-�SiT`�C� State: •--�--C�i.�.i�.� Zip: �� ` 3. Telephone Number: �J`�_' � I,�f.� "° ��'� 4. Date of Incident: ��,��i�'1 ��_'� �� ca?�/� � 5. Time of Incident: ��' .` � � !'�r'� 6. Location of Incident (Be specific): ��/ '� ��"�1�C�'t�'�°4�r1 �`i�^t'��< �/��C'r" `%��_= Cl'� �r ✓[�— l.�J �"ri.�'S�., .�T� 111,1 G%C�et.�i� 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.) �� / / �f-,�fi'�f � �'"C.l G�- G�� J I''f'C'_�I' i.'�B N'� L.�i'%.� l��Q C(,�/!�-�i /1.��'J�T \ b C� �! � ,V,� I C�� °' tJG�`�'C�� l�.r° ��C� i� s j'''l� r'�JY'��- /�� ' /�el� "j�L��'t�- � / 8. What were weather conditions like. � - �9—�-� `/��Ct � 9. Give name and address of any witnesses: � i � Z`-tC�� ' s+ 10. Did police investigate? (If so, give names of officers.) (;�b,--'�i��l�'I"� � � � 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � � -�' _ 4�c�/ C�1 R--tt� i� ��'C--��rL�0' .�'��t,°� �� re�S`�T a�i v`/$Sf G�/� � / ��o I� °7�'e� I—�►rl �j- %tj,�. �r� ��a r-'�' � "f�w1CS` �� o�i�L:C'� ��p— 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.) � � / `.� �C�� r �� e i�.,r °� /!1G�:�.J . 13. What other damages do you claim, if any? '� 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.) j1,'��/u" �-- 15. What amount do you claim from the City of Dubuque? 16. Why do you claim the City o Dubuque is r.esponsible? ^ ,.— ��Tre,� ��S �'�r��,•� "i� /-�c�� '�r�� /�'c�r�� /l��y� ��r_S 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) �c� 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�%'�d� l.��f� , 20/ �. � . � j�, b Z!Z- -.-- (Signature) /��/(' iL(�� °' �' (Print Name) � n � �-,- -�,�.,, r�,..� �,, � � � �+'t C �' � � � � � �? T j� (Rev. 5/18) CD �n � � �� m :� � � � � � � 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 � All•q��er�Ci� � �! � L wv�wri.ca�currait; i. `I�I �� . ; ZQ0�•2�I2•2�13 Masterpieee on thP Mississippi 201�*2o�.g ' � 1�RACEY STECKLEIN � PARALEGAL � i MEMO `' To: Ma or Ro D. Buol and I Y Y i Members of the City Council DATE: September 9, 2019 i RE: Claim Against the Cifiy of Dubuque by Michael Dorr � Cla�mant Date o#C�air� Dat� of Loss � Na#ure of Claim f Michael Dorr 09109/19 09/06/19 Vehicle Damage � This is a claim in which claimant alleges that his parked vehicle was damaged when a City tree lirnb fell onto claimant's vehicle at 2714 Broadway Street. � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. i cc: Michael C. Van Miiligen, City Manager � Tom Kramer, Urban Forester Michael Dorr € � � � � � 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