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Claim by Kaitln Kellogg 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 �L��c ��V J� y� �� , ��I C�., CLAIM AGAINST THE CITY OF DUBUQUE, IOWA � x � 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 ;;+I THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU 1 AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. 1. Name of Claimant: Kaitlin Kellogg 2. Address: 406 N 2ND St Cit : Bellevue State: �A Zi : 52031 � Y p l 3. Telephone Number: 563-543-5220 4. Date of Incident: 09�27��9 5. Time of Incident: �0:35 AM '1 V 6. Location of Incident (Be specific): Dubuque -2100 Locust St & W 9TH St � � � 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.) ' Horch was traveling norht on Locust St,when Kellogg was traveling east on W(th St collision ocuured � police report attached for review 8. What were weather conditions like? clear 9. Give name and address of any witnesses: none 10. Did police investigate? (If so, give names of officers.) acob Humpal 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). none � i 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.) � Ledt Front � '� �� a '13. What other damages do you claim, if any? left front '! �� l 14. Have you been compensated for any part or all of your claim by any insurance ii company? (If so, give name and address of insurance company and amount paid.) �� ; yes, Travelers Ins Po Box 5076 Hartford Ct,06102 $9797.77 was paid ''' I � 15. What amount do you claim from the City of Dubuque? { 9797.77 � � 16. Why do you claim the City of Dubuque is responsible? 'li failure to obev trafic control device ; i, ii 17. Have you made any claim against anyone else for damages as a result of this incident? �� (If yes, give name and address.) �I no i , � 18. If the answer to Question 17 is yes, have you received any payment from that source, 3 and if so, in what amount? i i� �� Dated at Dubuque, lowa this 20 day of January � 20 20 � �� Anna Lopes (Signature) C) � Anna Lopes a/so Travelers insurance (Print Name) �� ; � � � � ��_ � � ��? � � `�-�- -°��,. �"� c� �' °� .� � � �: �� : � � (Rev. 5/18) � � � � � � 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 i error, and that any review, disclosure, dissemination, distribution or copying of its contents u 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 j restrictions. ''� ',h I Confidential information may include the following: ;; 1) Social Security Number(s) �ii 2) Medical/Health Information � 3) Personnel/Disciplinary Information 4) Bank Account Information 5) Financiallnformation ,�I 6) Credit Card Numbers 1 'I 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. li�� ,� , i , � :� , I, , hereby certify that the attached documents � include the following protected information: � i Social Security Number(s) Bank Account Information i MedicaVHealth Information Financial Information � � Personnel/Disciplinary Information Credit Card IVumber(s) � � I' 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. Signature Date � � � 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 ',,. —�-- — Ail•A�aeica City � �w/ � i�i NNYJIWILOVICIF/f:LA: ,'I I�•� I 1Vl�sterpiece on the Mississippi 2oi�*2o 9 � , TRACEY STECKLEIN - � PARALEGAL ii MEMO To: Mayor Roy D. Buol and ; Members of the City Council ! DATE: January 27, 2020 RE: Claim Against the City of Dubuque by Kaitlin Kellogg , � Claimant Date of Claim Date of Loss Nature of Claim ' I Kaitlin Kellogg 01/24/20 09/27/19 Vehicle Damage I � i This is a claim in which claimant alleges that her vehicle was damaged after being struck � by a Gity of Dubuque police squad car at the intersection of W. 9t" and Locust Streets. ' � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa � Communities Assurance PooL � cc: Michael C. Van Milligen, City Manager Mark Dalsing, Chief of Police Kaitlin Kellogg 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