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Claim by Michael Nagelmaker 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 CLAIM AGAINST THE CITY OF DUBUQUE, IOWA 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. 13�' 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: �11 I I^C,�( a-�/I �a-q e%�-��L// 2. Address: �(l��1'� �YIQ,qGGLf'l�- �, City: � State: �fY� Zip: �b63 3. Telephone Number: �� — � � l/�JO 4. Date of Incident: ��/Y �g ��T 5. Time of Incident: lS� � D� 6. Location of Incident(Be specific): I.i J / X -G��,�c D�lagl79�f Y—Caor�;.�f� o�(� D�5�9�9 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.) Ch��S-t-�a,v K�e� +uQSc��'� rwo�DY�° �.t �a5 �.h��ut{ aDu��rvGu �.��-��'�ja+e WQS CNaN�e� oP�'� �oc�tl.S vJer.e ��;ag o��ee.t !1`.�.9ay l5� ��a��se�[ o�P►;.. . 8. What were weather conditions like? C .(I�Q.� �a�^►\ �b l�l 9. Give name and address of any witnesses: I��G-fVl/I�Q�BS�l�'LihlO�rir9y�, u�9�/�2'� �ont�,Ku� 2997/.� 39.��Iti� �//ec�eZ-� 10. Did police investigate? (If so, give names of officers.��O� �,n„d��,Jp,/'�(k(S'O f�vd/G�c�ia,S�e �1 a ��,� I�Jc� K� `v_°" �,�� 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � � l i I 12. Was any damage done to property? �If so, describe property and the extent of damages. Attach estimates af damages or describe basis for ascertaining extent of � damage.) �`l.t�'1 �'`C� � �`�..� � �`� i � � � � � 13. What other damages da you claim, if any? "�"��"� �L'''`)��V� pk��8�"' �� i ��`� ��0, t' � �� °�,� �� '�� 15 �t� � � � �, H e ou been com ensa#ed for an a r a in � '14. av y p y p rt o all of yc�ur claim by ny surance 1 company? {If so, give name and address of insurance company and amount pa�d.) , I ;I 15. What r�ount do ou claim from the City of D iauque? r ij �R� o�� .�-� � �1�� 1 16, Why d ou claim the C' f Du uque is res onsible? , � ��5�' �'�� `� ,� ��s ��a��° �1� � ��d��'�� I 77. Har�e you made any claim against anyone else for damages as a resu�t of this incident? ;� (if yes, give narne and�address.) � � � � � ,, { � 18. If the answer to Question 97' is yes, have you received any payment from that source, � and if say in what amount? � � � q i � �; Dated a# Dubuque, lowa this�day of fQ��(�� , 20�,,,. 3 � � � q � , � p k {Signature} k # � � � � � ��` -��'" (Print Name) � . . � � �. � . �4C� � �-e �. � �""� {-�-; I (Rev. 5118j �� -t �-..,,� � (� � �.�:.t � �-- . -_ � ,p cn � r"r� � � � �� .:_, � � � � � � �. � , �: � ` ! 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 your receipt of these items and destroy the communication and any attachments immediately. Further disclosure of this information may violate state and federal restrictions. Confidential information may include the following: 1) Social Security Number(s) 2) Medical/Health Information 3) Personnel/Disciplinary Information 4) Bank Account Inforrriation 5) Financial I�formation 6) Credit Card Numbers 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 information that is included. I, , hereby certify that the attached documents include the following p otected information: • Social Security Number(s) Bank Account Information MedicaUHealth Information Financial Information Personnel/Disciplinary Information Credit Card Number(s) 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 accordingly taking all precautions to protect my information from unnecessary distribution. �. �-��- �/—oy-�o� Signature Date 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 Dubuque THE CITY OF — Ali•A�erica City � V�/ �.�0 .i�i NAIY.?NLCMCIfIC'AJ[ 1III'°r Masterpiece on the Mississippi 2oi�*2oi� � , u a TRACEY STECKLEIN � PARALEGAL � ii MEMO � ;I To: Mayor Roy D. Buol and '� Members of the City Council � � DaTe: December 5, 2019 i� � RE: Claim Against the City of Dubuque by Michael Nagelmaker ? � Claimant Date of Claim Date of Loss Nature of Claim � Michael Na elmak r � g e 12/05/19 12/04/19 Vehicle Damage � 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 �' on the truck became unhitched and debris fell onto the roadway, damaging claimant's vehicle. i This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa I Communities Assurance PooL i cc: Michael C. Van Milligen, City Manager � John Klostermann, Public Works Director � Michael Nagelmaker � 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 � �