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Claim by Ashley MooreCity of Dubuque ITEM TITLE: SUMMARY: SUGGESTED DISPOSITION: ATTACHMENTS: Description Claim by Tamika Carr Claim by Jessica Lang Claim by Ashley Moore Claim by Brad Reicherts Copyrighted March 2, 2020 Consent Items # 2. Notice of Claims and Suits Tamika Carr for personal injury, Jessica Lang for personal injury, Ashley Moore for vehicle damage, Brad Reicherts for vehicle damage. Suggested Disposition: Receive and File; Refer to City Attorney Type Supporting Documentation Supporting Documentation Supporting Documentation Supporting Documentation 'ex/ CLAIM AGAINST THE CITY OF DUBUQUE, IOWA This written report constitutes your claim against the City of Dubuque, Iowa. 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. 13th 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: AFL 2. Address: Z 1 127 City:Ae-210uk- 3. Telephone Number: 4. Date of Incident: 5. Time of Incident: State: 6 8 1- Foy Zip: k 6. Location of Incident (Be )R?- 2x_h/1p ( oa_s p e s ecific :/CtJ L 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.) a aakaaa-boi \f\I -4h.)-73 /a hd C'C� CAS VLF W '� (, y--- `8. What were west r conditions ike? gre fr-- IN ea-it(h- �- 9. Give name and address of any witnesses: a �►t� ! Q I' - 10. Did police investigate? (If so, give names of officers.) 0 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). 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.) e/e. a-40( Ch(6( 5 , ov\in ChYv1,E�. 13. What other damages you claim, if an G --Fry fl Jl -Fuckzcs b dcso ►-e-t'►eAA) be-i' --e l I-) cod- o-r 5aV 14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give name and address of insurance company and amount paid.) /Vd 15. W at amount do you claim from the City of Dubuque? buque? rb - rigeed. -- - j,� ©u Who 16. Why do you claim the City of Dubuque is responsible? 17. Have you mane. eny ciainh agalnstfau. mne else for damages as a result of this incident? (If yes, give name and address.) No 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? A j Dated at Dubuque, Iowa this day of 1 i 7A , 20 . /02i-t8 A--(4\M Moovp, (Rev. 5/18) (Signature) (Print Name) 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 Information 5) Financial Information 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. 1, st1,1,e0 include the followag protected information: Social Security Number(s) Medical/Health Information Personnel/Disciplinary Information , hereby certify that the attached documents Bank Account Information Financial 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. Date Copyrighted March 2, 2020 City of Dubuque Consent Items # 3. ITEM TITLE: Disposition of Claims SUMMARY: City Attorney advising that the following claims have been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool: Tamika Carr for personal injury, Jessica Lange for personal injury, Ashley Moore for vehicle damage, Brad Reicherts for vehicle damage, and Emily Treanor for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type I CAP Referrals Staff Memo Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL MEMO -)fk To: Mayor Roy D. Buol and Members of the City Council Dubuque * * * AII•Aieric City NroX?W.UW WAIF.' '1111' 2007.2012•2013 2017*2019 DATE: February 26, 2020 RE: Claim Against the City of Dubuque by Ashley Moore Claimant Date of Claim Date of Loss Nature of Claim Ashley Moore 02/26/20 02/18/20 Vehicle Damage This is a claim in which claimant alleges that her vehicle was damaged due to salt seeping through a crack in the cement above her parking stall #269 in the Iowa Street Parking Ramp. This claim has been referred to the Iowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager Russ Stecklein, Transportation Department Field Operations Supervisor Ashley Moore OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL tsteckle@cityofdubuque.org