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Claim by John Kueter Copyrighted December 16, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Nancy Fettforvehicle damage; Lawrence Hutton, Jr. for vehicle damage; Jonathan Kueter for vehicle damage; Michael Nagelmaker for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Claim by Nancy Fett Supporting Documentation Claim by Lawrence Hutton, Jr. Supporting Documentation Claim by John Kueter Supporting Documentation Claim by Michael Nagelmaker Supporting Documentation �� a GLAINI AG��N�T THE �ITY OF DUF3UQUE, It�WA � � �� . '� �G� '�� This written report constitutes yc�ur claim against the City of Dubuque, lowa. You shc�uld ;€ camplete this form in full and attach any additional information that supparts yaur claim. � . � ,� 3 The Claim must be filed with the City Clerk at City Hall, 5t} W. 13th St., Dubuque, IA �2�01. It i� will then be referred by the City Council ta the appropriate department for investigatian. � �}nce that investigati�n is completed, a report and recammenclation will be submitted tc� the City Gaur�cil. Yau will be provicled with a copy of that report anc! recammendation. � c THE FINAL DECISIC}N C}N ALL CLA(MS !S MADE �Y THE CITY GQUNCI�. Nt� E�VIPLC}YEE OF � 7 THE CITY C7F E�UBUQUE HAS THE At1THORITY TQ MAKE ANY REPRESENTATIC?N T{� YOI� � �; AS TO 1NHETHER Yt3UR CLAIM W1�� (�R WlL, N{aT BE PAID. � � 1. Name af Claimant: ``�� I �. Address: �_ � �� r� l, � , � � City: `. ` ` '� State: �� Zip: �J � � � — � �. T+��pF��r�� i�umber: � .:��r-- ,5�,�� ,� ��C,� ; ;; 4. Date c�f Incident; _ ��'��/� 5. Time of Incident: �� I; 6. t�ocation c�f Incident (Be specific}: t � � � � +��, � � �''�.�� ` � ��' � 'I II � ?. DESCRlBE ACCIE�ENT t�R C?CCURRENCE THAT CAUSED INJURY 4R C7AMAGE. (�ive � ful� details upon v�vhich you base yc�ur c�aim. [f a City employee was involved, give the employ��'s r�am�.} � � � � �� t �z �c��' �� - � � �t a ��.. C` �a� �,. � �IC � �'?�rz ra`,�e� f�� ir i s �'�� ` fi �. 1iVhat were weath�r conditions like? �9�"C�,.�,. � ,��, -Q ¢ 9. Give name and address of ar�y witnesses: �tf 4� 10. C3id pol�ce inuestigate"� (If so, give names of officers.} � � � I�.r� �'� � � 11. V1la� a�tyene ir�juree�? (If sa� give names, a�dr�sses, and extent of in�urees). � �� . a E 1�. Wa� any damage clone tc� property'� (If so, describe praperty and the �xtent of � damages. Attach estimates of damages c�r describe basis for ascerfiaining extent of � damage.} � �;��- � �- �-- �r-� . �r+�.� �c�� v+�.� � � ; � 13, What other damages do you ctaim, if any? /��7 ��1�3�t �� "c:�r' � �� i , , � '14. Have yor� been compensated for any parfi or all of your claim by any in�urance company? {lf so, give narne and address of insurance company and amcrunt paid.) � �� 15. What am nt do you claim from the Gity of Dubuaue? ' �� ;� 16. Why do ycau claim the Ci y af C}ubuque is resp sibte? � C t.' J`�" �� G'�$YYd^� C"��. �,#" � � � R 17. Have yau rnade any claim a�ainst anyone else far damages as a result af thi� incident? � (If yes, give name and address, � � � '� 1�. If the answer to Qu�stion 17 is yes, have you rec�ived �ny paymenfi from th�t source, � and if sa, in vuhat amaunt? � y � �. � „ Dated at Dubuque, lowa this_�`�day of_ �� , �U /`� , � � �� = ,� w� P�-- �. _a �_�.� � �.� _-- �- � .�—� - (Signature� _��/ � ''" ` ;�3 � � ��1. � (Print t�ame) —f,� � ��-> � '�, �-�a �, � ,� �� ,� cs'.� .� t�-' � � �' a�4j!g :C7 � � '`�, - �'~� "_":. � � '> '—�"*., � C ��/. rJ�� ......; �w � � � I a � � � Confidentia�l � This cornmur►ication and any attachments may cantain infarmation which is confidential � and privileged by (aw and is for the use of the designated recipient. If yau are not the � intended recipient, you are hereby notified that you have received this communication 9n � error, and that �ny review, discic�sure, disseminatior�, distr�butian or copying of its contents � is prohibi�ed. Please nc�tify City af Dubuque immediately by tel�phone at (563)-589-4120 of your receipt of tt�ese items anc! d�stroy the communication and any att�chments � immediate[y. Further dasclosure of this information may viotate state and federal � restricti�ns. � � � � �� i � Canfidentia� information may include the foClowing: ; � 1} �r�cial5ecurity Number�s) � 2} M�dic�l/N�alth Infiarmation � � 3) Personnel/DiscipCinary Information 4) Bank Aecount Information ;; 5) �'inanciallnfc�rmation �� redit �ar� N�mbers i i �f any documentatian you desire ta submit to the City of Dubuque contains any c�f the items abova this cover sheet must be attached direc#fy ta the confidential infarmation ana indieate the type of � information that is included. � � � � � �' , , i I, �. � , hereby certify th�t the attached documents � include the follflwing pratected information: ' �� Social Securi#y �lumber{s} Bank Account Inform�tion � a � Medical/H�alth lnformation Financial Information � � PersonneUDisciplir�ary Inft�rmation Credit Gard Number(s) � � I a�nderstand'that this infarmation may be distributed within the City organization ar to agents �f the � G City for processing and ! hereby authorize the City to act accordingly tak�ng all precauti�ns to � protect my information from unnecessary distribution. � a �� -�-�:=.. r'.�-�� ;� r,at�are � �`" Date � � � � � � , 9 � � I Copyrighted December 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: Lawrence Hutton, Jr. for vehicle damage/personal injury; Jonathan Kueter for vehicle damage; Michael Nagelmaker for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation � Dtabuque � THE CITY OF Ali�Amsrica City � _ M� � NAIY."MWLCfVICI�Y(.XNi � , III'�� Maste iece on the Mississi i 2ao�•2a1z`2013 � � �p 2017*2019 � � 7 f�� J TRACEY STECKLEIN ' PARALEGAL �� MEMO � �. To: Mayor Roy D. Buol and 'I Members of the City Council �i � I � DATE: December 4, 2019 ,i� i� ik RE: Claim Against the City of Dubuque by Jonathan Kueter I! F; Clairnant Date of Claim Date of Loss Nature of Claim ;I �; � Jonathan Kueter 12/04/19 12/04/19 Vehicle Damage Il ; This is a claim in which claimant alleges that as he was following a City of Dubuque Public ,�' Works truck south bound on Highway 151 north of the South Grandview Exit, the tailgate i on the truck became unhitched and debris fell onto the roadway, damaging claimant's vehicle. J �� 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 Milligen, City Manager � John Klostermann, Public Works Director Jonathan Kueter � 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/EMa,i� tsteckle@cityofdubuque.org