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Claim by Ronald Cathey Copyrighted February 4, 2020 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Jessi Brokus for vehicle damage; Ronald Catheyfor vehicle damage, Greg Howell for vehicle damage; Kaitlin Kellogg for vehicle damage; Kelsey Meyer for vehicle damage; W illiam Leibfried for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Claim by W illiam Brokus Supporting Documentation Claim by Ronald Cathey Supporting Documentation Claim by Greg Howell Supporting Documentation Claim by Kaitlin Kellogg Supporting Documentation Claim by Kelsey Meyer Supporting Documentation Claim by W illiam Leibfried Supporting Documentation � � ��. �LAIM AGAINST THE �ITY 4F DUBUQU�, IOWA • �� L�� L��.'�",�� This written report consti�u�es your claim against the City of Dubuque, lowa. Yr�u should � complete this fc►rm in full and attach any additional informatian that supports your claim. � � The Glaim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001. It � will then be referred by the City Cauncil �a the apprc�praate department for investigation. � C"�nce that investigation is completed, a report and recommendation wilt be submitted to the City Gc�uncil. You wi11 be �ravided wi�h a copy r�f that repart and recammendation. � � THE FINAL DECISICIN C7N ALL Ct..AtMS IS MADE BY THE GITY Ct�UNCI�. NO EMPL{}YEE UF THE CITY t)F DUBUQUE HAS THE AUTH{�R1TY TQ NIAKE ANY REPRESENTATIC}N TQ YOU AS TO WHETHER YOUR CLAIM WIL� C.}R WILL. NQT BE PAID. ( 1. Name af Glaimant: � � ��-.�' �� --��r�"� '' �o a4ddr�� -� �� '��-�.� ��v"�.s�'°�'" � i r � _; City: �t.�� =� State• � Zip � °' . ' � �� _ � „ �3. Telephone Nurnber: �� } �---�� ` h, i 40 [�ate o�Ir�cident: �/,�Ii�i ��-� � � �i 5, Tirne of fncident: ��-�`�.r�.�.a� � ��`""�� '�[ � �'��,�, . � � � i; �Y' n-�� r �'�� - s! 6. Laca�ion of Incident {Be specific}: k � � �� .;��.�c��'� � 7. DESCRIBE ACCIDENT {�R QCGURRENCE THAT CAUSED INJURY OR DAMAGE, (Give j � full details upon which you base your claim. If a City employee was involved, give the � employee's name.} � e� �� "��,�'` �,3-�,=. � e� , � � � �� 8. What were weather c ditions I�ke? 9. Give name and address any witnesses: 10. Did police investigat�? {If o, give �ames of of�cers.) � � �11. Was anyone injured? (If so, give names, addresses, and extent of injuries}. � � u , � ;; , � � � �2. V1/as any damage dane ta property? {ff so, describe praperiy and the extent af damages. Attach estimates of damages or describe basis for asce�Eaining extent af damage.} � � � � � �� I '13. What other damages do you claim, if any? 1�`�� ,; � 14. Have you been compensated far any part or all of your claim by any insurance � company? {If sa, give name and addr�ss of insurance campany and amaunt paid.} 3 ] r`�U ; � '1�, What arnaunt dc� you clairn from the City of D�buque? � ��"°" "� � '` � �. P 16. Why do you claim the City of Dul�uque is r spon�ible? ; �= �_ --� ` � t.�P ? ;{ � 17. Have you made any claim against anyane else f+�r damages as a result of this incident? � tiT yes, give name anci acidress.j ; Af� " °��. If �h� ar��e� �� t�u�sti�n �7 i� y��, h�v� you r��c�i�r�c� �ny paymen� frc�m that source, �,� and if sc�3 in what amount? � �� Dated at Dubuc�ue, lawa �this � � day of �' � , 20,�� {�ignature} � �(1 l�'+�4�.-D (Print Nar�ne) � � ��-;�•�:' � ;,�"', � � � � � �„ � � � � � � � r�r � {Rev, 5/1�� -�, �; r„�,� � � � � � � � � � � � � �t�1"1'��t�GM"1�1�� This cc�mmunication and any attachments may contain information which is confidential � and privileged by law and is for the use 4f the designated recipient. [f you are not the � intended recipient, yau are hereby natified that yc�u have received this communicatit�n in error, and that any review, disc�osure, dissemination, distributian or copying of its contents is prohibited. Please nc�tify City of Dubuque irnmediately by telephane at {563}-589-4120 af = 1 your receipt of these iterns and destray the communicati�n and any attachments '� immediately. Further disclosure of this in#ormatian may violate state and federal ,'i restrictions. ; , � �an�dentia! infarmation may include the follawing: � � 1} Social Security Number(s) � 2) Medical/Health Infc�rmation ' 3) PersannellDisciplinary Ir�formatiar� ;� 4} Bank Account Inform�tic�n � 5� Financiallr�ft�rmatic�n a �} �redit Card Nurnbers � � � � If any d�cumentation you desire tc� submit to the City of Dubuque contains any c�f the items abc�ve ; this cc�ver sheet must be attached directly ta th� cc�r�fidential information and indicate the type c�f � information that is included. � � 'i a a i I, , hereby certify that the attached documents � include the following protected information: � � Socia( Security Number�s} Bank Account lnformation � � � MedicaVFlealth Information Financial Infarmatian � � � � Persc�nnel/Disciplinary Infarmatic�n Credit Card Nurnber(s} " � I understand that this infarmatic�n may be distributed within the City orgar►ization or to agents of the � �ity fc�r �rocess�ng and I hereby authorize the �Ety to act accordingly �aking all precautions to protect my information from unnecessary distribution. _--- � Signature D�te � G � � Copyrighted February 4, 2020 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: Jessie Brokus for vehicle damage; Greg Howell for vehicle damage; Kaitlin Kellogg for vehicle damage; and William Leibfried for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo Dubuque THE CITY OF �w --- Ali•America City L��CTl3 E ��,}�.a�, � �� I��► Maste iece on the Mississi i 2oo�.Zo�z•�o�3 � �P pp zo1�*zo�.9 TRACEY STECKLEIN PARALEGAL MEMO I� To: Mayor Roy D. Buol and Ij Members of the City Council � ; DaT�: January 29, 2020 II� , R�: Claim Against the City of Dubuque by Ronald J. Cathey �; Claimant Date of Ctaim Da#e of Loss IVa#ure of Claim � ; ; Ronald J. Cathey 01/27/20 01/18/20 Vehicle Damage � i , This is a claim in which claimant alleges that his vehicle which was park�d at the Jule Operations and Training Center was struck by a City of Dubuque Transportation Services Department vehicle. ; , This claim has been referred to the lowa Communities Assurance Pool. i cc: Michael C. Van Milligen, City Manager Russ Stecklein, Transportation Services Department Field Supervisor Ronald J. Cathey � 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