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Claim by William Leibfried 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 �� . � . �� CC.AIM AGAlNST 1"i�lE C1YY` �F DUBUQ�lIE, IC�WA � � This written report constitutes your claim againsfi the City of Dubuque, lowa. You shouCd � camplete this form in full and attach arty additional informatiar� that suppor�s yc�ur claim. � The Claim must be filed with the City G1erk at City Ha1i, 50 W. '13�" Sfi., Dubuque, IA 52Q01, It � will thert be ref�rred by the City Cauncil to the approp�iate depa�trnent fa� in�estigatior�. � flnce that investigation is completed, a repart and recammendatian wiil be submitted to the ; City Council. Yau witl be pravided with a copy af tnat report and recommendation. '� � THE FINAL DEClS1UN UN ALL CLAIMS �S MADE BY TF�E CITY C{}UNCIL. NO EMP�OYE� OF � _ _ .__ � �'HE C1TY C?F DUBUt�UE FIAS THE AUTHORiTY TO MAKE ANY REPRESENTATION TO YOU 1 AS TC} WHETHER YI�UR CLAIM WILL t}R WILI� NflT BE PAID. k � 1. Name of Claimant: ,��y ��.1 �_�,�'1,*'�. } �" _�,�?� �� Y't��. � � . '� � "� � �� A��ress: �,�,� � � ��r-1��.� ��. �'", � � . c CitY:�� State: ,�� Zip: � ; �u . � �. Telephone Number: �;`r ,�,�.-�'I �.� � �� - � � �� "f-� �I ,� ;i 4�: Date of lncident, �' � �c� �.��..t�� ;1 a °� �,�_ � 5. Time o; IncidentE ��i �-� �I'`� �� ' � 6, Le�cafiic�� e��9�cid��t {�e �pe�if�c.�: ��'��Y°l{1��.��'��' `�'� , � � � � 1l�'1 � ,� ��.1..,�. `��` � � � � i 7. DESCRIBE ACCiQENT QR QCCURRENCE THAT CAUSED 1NJURY C}R DAMAGE. (Give '! futl detai�s upan which yau base yaur ctaim. If a City employee was invalved, giv� the � employee's name.� �(,,�-�� .�"��.. ��t �.��[�'C�� _ �' �"' �j�'�.�? �l?��c� �� 1.�.. t"�.�. �' �.� ` c�,�.. �� y ��.�� -°� � , �. �� 8. What were weafiher conditions like? `��Q i �,�_� �� `3�.�..-�"' � 9. Give name and address af any witnesses: � � 10. Did pc�lice invesfiigate? (If so, give names of officers.) � ; � ; ` � �� 1�� 1'1. Was anyQn� injzared'? �lf so, give names, addresses, and extent of injuries}. � 4 � � �1�. Was any damage done to property? {If so, describe praperty and the exten� of darnac�es. Attach est�mates of damages c�r describe basis for ascertaineng extent of damage,} � � �� r�� .�� , a—��--.�._ � � 'i �`�,� --�-�..... ; '��. What other damages do you claim, if any? � '� � ? � � 14. Have you been �ompensated -for any part ar all of your c[aim by any insurance company? {If so, give name and address of insurance company and amouint paid.} ' ,i � � 15. What amount do jrou claim from the;City of Dubuque��```�'' i �_...� ,a:� �� 7 � - � 16. Why do you c�aim the City af C�ubuque is responsible�,� � ; C.�t �-� �� `� �`�'(�`��;'-�-�`:,' : ; _ , ,� 17. Have yoc� made any claim against anyone etse for damages as a result of this inc�dent? ; {If yes, give name and a�ldress,) y ' � 1�. If the answer to Q�estion 17 �s yes, have you received any paymer�t from that source, � and if so, in what amount'? � � g . . . ._ . � . . . . � l��ted at Dubuque, towaa this day of �� , 2� g 4` � � �� w. � l � - � @� ��°� � �� {SlgtlatUre} � �'" ��..�` � l� i�f�, ..��, C..�"'% �} ��+ �� (Print Name} � � �"�� c� � � � � . � � � � � � �� {��Vs �r�� s , . �, +Gonfidential This communieation and any attachments may conta�n information w�ich is confidential , and privileged by law and ;is far the use of the designated recipient. lf you are na� the intended recipient, you are hereby notified that yau have received this cc�mmunication in � errar, and that any review, disclosure,'dissemination, distributic�n or�opying of its cc�ntents � is prohibited. Please notify City of Dubuque immediately by telephone at (563}-5$9•A�'!2U of your receipt of these items �nd destroy the commuriication ;and > any attachm�nts immediately. Further disclosure of thi� information may ,vialate s�ate arid federal restrictions. { � � Cc�nfidential information rnay include the fallowing. ` ` � �� o�ia] Security Number(s} ' } dicallHeal�h Information h 3) _Persanr�el/Disciplinary lnformation . . � 4) Bank Account Infic�rmatian � 5} ,Fin�ncial Inforrnation 6} Credit Card Numbers � _ : ii If arry doc�mentation you desire to submit to the Gity of Dubuque cantains any r�f the items above � this cover sheet must �e attached directly to the cc�nfidential informatian and indicate the type af �� information that is included, ' : , ;� ,i � � _ , hereby cer�i�y that the attached �ocuments � � include the foClc�wing protected informati�n; � _ � � � a Social Security Numb�r{s) Bank Account Information � F MedicallHealth Informatian Fin�ncial Informatic�n � � � � PersonnellDisciplinary lnformation Credit Card Number{s) 1 und�rstand that this intarmatior� may b� distributed within the City �rganization �r tc� agents of the � Gity for processing and I hereby autht�rize the City tt� act accor�ingly taking al] precautions to a protect my information from unnecessary distribu#ic�n. , � ,✓�' f .� �5'r i.��. � �j� .,�� r��f �{�r �x f"� �„ ,,�° . � r�W F � � p��l..�f� �4,.✓ . . f �""1 � l.. �.,� t � L- �IC�(l�ttll'2 r'�'� W D��B � 3 j � 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 �� --■ All•Ameeica City �� wttcna�aNc�rrun: ,' , ► �I 2007•2012•2013 � Masterpiece on the Mississippi 2oi�*2oi9 � � I�RACEY STECKLEIN � ° I�ARALEGAL � � IVIEMO � To: Mayor Roy D. Buol and j Members of the City Council I' DATE: January 17, 2020 V U ii RE: Claim Against the City of Dubuque by William Leibfried �I; �' Claimant Date of Claim Date of Loss Nature of Claim �j William Leibfried 01/17/20 01/16/20 Vehicle Damage Ij':. �� This is a claim in which claimant alleges that his vehicle which was parked near 1450 ; Rhomberg Avenue was damaged when struck by a City of Dubuque Jule bus. This claim has been referred to lowa Communities Assurance Pool (ICAP). �I cc: Michael C. Van Milligen, City Manager � Russ Stecklein, Transportation Services Field Operations Supervisor � William Leibfried � � OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/F,vc (563)583-1040/Ennai� tsteckle@cityofdubuque.org