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Claim by George Langas Copyrighted November4, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Jerome Ehlers for property damage, John Koenig for property damage, George Langas for personal injury, Julie Rupert for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Ehlers Claim Supporting Documentation Koenig Claim Supporting Documentation Langas Claim Supporting Documentation Rupert Claim Supporting Documentation ��� • ���� `��,�¢ ����. CLl��lVl AUAIh�S`� TH� G�T`� C�F DU�I�QUE, �€7110P� �'�,��c�, 1'his writ�en repoefi constitutes your �laim agairtst the City af Dt�b�que, low�� You shouid complete tfiis form i�f�i1 and at�ach an�t addition�l infarmation that supports your cl�ir�. � T�e Cla�m m�ast!ae filed w�th th� City Clerk�t City Hatfx �f�VIf. 't3th 5�., L�ubuc�ue, [A �20�}�1. f# � wi14 ther� be r+ef�rred fi�y the City Cou,n+�i6 �o the apprc�pria�e dep�efimer�t far Enuestic�ation. � t3€tce that in�esti��ti�n is �om�leted, � repoe# and rec�mmenda�ion wil� be su�k�mitt�d to t�e � City Council. You wilt be pro�ided w�th a �opy of that r�par�and recommendati+�ne � � THE F�NAL I}ECIS1C3lN 4N A�L CLANM� 1� MAD� BY THE aC#TY GC}UNCI�. NC} E�PL.C?YEE C}� �i THE ��TY {�F DU!�UQtlE H/�S THE A8�1�Ht}�t1TY TC3 IidtA�C� AN� RI���ESEN�'AT'IC1N TD Yt?U' A�TO 11VHETF�ER YC}C��# Gl.A�M'�11d1l.L C3EC W#�.� [��T �E PA�L�. `' � �l. Name c�f Ctaimant: `"'` � ' e 2 ,�� ����'�'l�S: � C �'ilt�(: =��w��� ,. 1��...,,....._ �'�+�t4': ��b��'�� � �tp: ��`�� � � ��.��� � �. �`e�eph�ne Nu�nber; � � � � "�iC�� I;: I c "" � � �� ' �. Qate of It�cid�n#: ` I �. Time of inc��et�t: ` � � m � ! 6. �ocati�r� of�ncid+��t(�e s�eci:fic�: ° �`���X ! � ; � A� � 7. I�E��RI�E �CCIDEN�" QR QGCllRi�E��E T�AT CAU��U 1N.11�1�Y t'�i� [3AIi�A►GE. �£�iv� #ull deta�ls r�p�n which yau �ase you� �la�m. If a City employee v��s �n�ol�red, gi�e t�e ; er�r�pl�y��'s r��me.� �� �`f��t ti � � � ��l � � , �y � ; : � , - �, . t�. . b �" l�.. �, 1�Vhat wer��veath�r��nclitioa�s like'� 9. Ci�e nam�and �dciress c�f any witness�s: �°°~ �10. Did patic+� investig�te'� (If so, c���re narnes o�af�cer�.j � 11. '�dtidas anyane in�ured'? {If so, +�ive names, addresses, �t�c� e�ct�nt of ir�juries}. �� � �x � �� �,��/�4 �.��G�-� l��i� �[� �,.J c'v� .�.�`� �°C� �:�({�� C � � � ��� � � '� �� ��� � � � `, , � t��� .,�'°� o .� �r.� �:�c� �� � � � ��.��� ��.`c.l.�. �t.� � ��� � �. � - � � � , � � ��-�� � r��. ��� �,�,L i p � � � � c��l�c� �r�-� � � �.� � �- ��� ��1 /I �pp� � � � � `�.J��-�C\"V L�'�. "`"'�✓0..� �►'�� S s�� �'��� � �� �'�"^w.3 �III V �a�r' . � ��,� �.� �a� � 'I !;� � �l G � . . . .. . , . .. . . � � � � 1 I �i _ � � �� J h i, i i �'I I � I� � � '!2. I�as any da�nag� dane to property? (If so, describe properE�t and the e�cten� c�f ; damag��. Att�ci� estimates of damages or de�cribe basi� far ascertain�ng extent af � damage.� � � �� - ��.- � �� ��. t � �� � , � 73. INhat other darrtages do you clainn, if any? � � � �� � ... ���� r , � � � �,� j 14. t�ave yau been c�rr�pensa#e�l �crr any ��r� ar all c�f your claim by a�;� ins�ran�� com�an�? �If so gi�r� �nar�e��� �ddress a��n��r�a�c��c�rnp�n�+��d �re�s������ad.} ; . .; '�Y ~ c..d'� �'' t�. ��.� � � � 15. 11VV`hat�r�ou��dv �c�� �1�� fram the G�ty af Edu�iu+q�e? �,� 3 f� 'I �I 9�. '�'`h do ycau clairn tne Gity t�f�ubuque �s r�,s���sible'� � w ;� �7. Have you �ad�an��I��rn a�ains�ae��one else for damac�es as a res�Ct o�this �n�ident� i �If yes, �give narne�r�d �ct�r��sa1 t� '� � � � 'E � , � '18. !f the an�mver to C�uestior� 17 is yes, hau� you re�+�%�e� a�y payrr�ent fror� that soc�r�e, ; and if sa, in vv�a�arr�aun�'? ;' � L��tet�afi E�ubu�ue, lov� thi����-d�� �f ��''.���` , ��l���,a j � ;i 7 � ,� �Y�` - w �` (�i�nata:re� � � �' �� � � {Print�dame} �.� � `;��.°'�` c� � � �" � � � � ���v� S/9�) � � � � � � � � � � � � ' � � � � � � � � � � a � � j I Confidential i This communication and any attachrnents may contain 'rnformation which is confidential 'I and privileged by 1aw and is for the use of the designated recipient. If you are not the i intended recipient, you are hereby notified that you have received this communication in ��� error, and that any revi�w, disclosure, dissemination, distribution or copying of 'rts contents �� is prohilaited. Ple�se notify City of Dubuque immediately by telephone at (563)-a$;9-4120 of i� your receipt of these iterns and destrmy the communication and any attachments �' immediateiy. Further disclosure of this informatio� may violate state and federal �'� restrictions. ;j ; Confidentia6 information may ineCude the foflow6ng: ; i; 1) Soeial Secur`ity Nurnber(s} '� 2) Medical/Health Bnformation i 3) Pers�nneVDiscipl'ena�r Information � 4} Bank Account Information � 5) Financiallr�forrnation � 6} Credit Card Numbers If any documentation you desire to submit tc� the City of D�abuque contains any of the it�ms above this cover sheet must be attached directly to the confidential information and indicate the type of in#ormation that is included. � ii ; I, �'� j "�,�`�' � �' , �rereby certify that the attached documents � include the fo110 " g protected i mation: � a Social Sec�+►`ity N�+mbef(s) �Bar�k Accour�# Inforr�ation Medical/H�alth fn�ormation Financial Info�'m�tion � P�rsonnel/Discipfinary fnfarmatior� Cred�t Card N'urnber(s} � � � 'i 1 understand that t�ris informa#ion may be distributed within the City organization or to agents of the ;; f`�4�i f^r �+rO�QS�in�t. arZr"] I hord�.'�,� al..'±�Or��e t�':� C�t�i 4:; �Ct ���OfM�n�l'�/ 4�1�:^y u�� �,^.f�.^.�"..�'t!^!'�� �.^> � profiect my in#ormation frorn un�ecessary distribution. � H � ,,.� ,�, .� l� .� signature Date � � � � � j1 E G, il P a k, -0 Jg I Copyrighted November4, 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 forthe IowaCommunitiesAssurance Pool: Jerome Ehlers for property damage, John Koenig for property damage, George Langas for personal injury, Julie Rupert for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo Dubuqu� THE CITY OF � � .s All•A�ericaCily , � A�" � � NAIOIWILCMCtIIt'LY: r' ��'.r Masterpiece on the Mississippi 2oi�*2oi� �� h � H li �X�,,� I TRACEY STECKLEIN f�'[ ,�' � PARALEGAL .1., �, 1111 E M O � , il 1'0: Mayor�Roy D. Buol and � �� Members of the City Council ;� � DATE: October 22, 2019 � � RE: Claim Against the City of Dubuque by George P. Langas � , Claimant Date of Claim Date of Loss Nature of Claim � ;I George Langas 10/22/19 07//18/19 Personal Injury j !i This is a claim in which claimant alleges that he was injured after being rear-ended by a I! City of Dubuque Jule bus when he was traveling north on the NW Arterial in a USPS mail �'' truck, attempting to make a right turn onto Pennsylvania Avenue. ! i I This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa � Cor�i�unities Assurance Pool. � � cc: Michael C. Van Milligen, City Manager � Russ Stecklein, Transportation Services Field Supervisor Renes Tyler, Director of Transportation Services � George P. Langas � � . � � � � � 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/EMaiL tsteckle@cityofdubuque.org