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Claim by Optum/Auto Owners Ins. Co. Jo Witterholt Weigel Copyrighted December 21, 2020 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: Michael Dressler for property damage; Optum on behalf of its Client, Auto Owners Ins. Co./Jo Witterholt Weigel, for property damage; Amy Ressler for property damage. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Claim by Michael Dressler Supporting Documentation Claim by Amy Ressler Supporting Documentation Claim by Optum Supporting Documentation � ,� �`. :a= .� ��61 u ��Ili ��V15�� P�rY ""TV�� ',�� aX�� uf�vill�,!tY 4Q�33-��2� il December 3 , 2020 � � I; CITY CLERKS OFFICE I�� I CITY OF DUBUQUE ; 50 W 13TH STREET ' DUBUQUE IA 52001 ' RE: Our Insured: Jo Witterholt Weigel I�;; Our Client: AUTO OWNERS INS COMPANY �'� Date of Incident: 5/2/2020 �� Event fVumber: TPCS - 6508782 - 10404067 Amount Paid: $5000.00 ' �% To Whom It May Concern: I I��I Optum has been retained to handle the subrogation portion of this claim by AUTO OWNERS INS COMPANY. I understand that you may have previously been contacted by a(n)AUTO OWNERS INS COMPANY adjuster. Please direct any future correspondence, telephone calls, or paym�nts to Optum at the address listed above. j Be sure to include the Optum event number(TPCS - 6508782 - 10404067), on any documents you send. Prior to �I issuing any checks, please contact me at the number listed below to verify full payment is being sent, 'i � � Our investigation reveals that you or your insurance company is responsible for the repayment of the insured's ;I, damages. We are hereby advising you of our right of recovery. �li � If you are insured, please forward this letter to your insurance company or call me today with your insurance � company information so that we many contact them directly. ,� I� P/ease note, in order for the recove to be ro erl a lied it is im erative that ou �' �'Y p P Y pp � p Y , forward your check made payable to: � Optum � P.O.Box 36220 � Louisville, KY 40233-6220 � � Sincerely, � � ��0'"� ��''`� �� . � �"?-' Scott L. Randall � �. ,�-- (,.� (502) 214-1431 � r�' � � �,� .� I'_i"t TPCS - 6508782 - 10404067/ZSDNIE c�ta -�" � � � � � � � � � �� Le��.� � � klo5��-��.�� '� CLAIM AGAINST THE CITY OF DUBUQUE, IOINA �, �,��'-�— r I� This written repart constitutes your claim against the City of Dubuque, lowa. You should „ complete this form in full and attach any additional infarmation that supports your claim. i; � 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 recammendation. ' �; �; i. �� 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. i; '; 1. Name of Claimant: 0 d!�(/� �,�9r1/�'i � � �, � 2. Address: ��• ��.2oZ� 'd City: �U�`��,�F%/� State: � Zip: c/D ,�,_ I! �, � 3. TelephoneNurnber: ,��-a/��J j 'i 4. Date of Incident: 7�- c� '�v2� 'I 5. Time af Incident: ��/� %�� _ �I 6. Location af Incident (Be specific): ,,�p�j�j /��/rJ,%��¢/ 1�,7`� /�/C�,��(�l�P,-,�� I��O/%T j ;� �� i��-e�� ' , q k 7. DESCRIBE ACCIDENT OR OCGURRENCE THAT CAUSED INJURY OR DAMAGE. (Give ' full details u on which ou base our claim. If a Cit em lo ee was involved �� p Y Y Y p Y , give the ! employee's name.� 5��f ,� L lv1/ G � �` �'c' �c�'C��.�'� f'�?P�' I � � 8. What were weather canditions like? -�✓/.� ;. , 9. Give name and address of any witnesses: �, � 10. Did palice investigate? (If so, give names of afficers.) /v /� � 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). �'�' � � � e � ; � � II � 12. Was any damage done to property? (If so, describe property and the extent of � damages. Attach estimates of damages ar describe basis for ascertaining extent of j damage.) � d �� r�,�c�r,�,0 G'��'� I� i � 13. What other damages do yau claim, if any? �I�Io�yT �ri�� ,�"�sr�.�� car/e�•�� ' ,i �i 14. Have you been compensated for any part or all of your claim by any insurance ;I campany? (If so, give name and address af insurance company and amount paid.) ;� -/J j� �� af'P?' /�rl,�t`I E'f� ��"�1� ,l �� 15. What amount cEo ou claim from the City of Dubuque? ��i �� Ili 16. Why do yau claim the C�ty of Dubuque is res onsible? , 7�P�i2 C,�iP �/�' ��P��' 17. Have yau made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) � ;'; ; � 18. If the answer to Question 17 is yes, have you received any payment from that sourc�, and if so, in what amount? i � Dated at Dubuque, lowa this�day of �� , 20�. �� i; � (Signatur�) � � i l.»( � ��4'r,� ��%�/��/ �� (Print Name) ,:x ,� c� � k._.� r*�€ � �� C.`� � � � � � � � � � � � .�.� — � (Rev. 5/18) �' �;� � � €aa � � � � Copyrighted December 21, 2020 City of Dubuque Consent Items # 3. City Council Meeting ITEM TITLE: Disposition of Claims SUMMARY: CityAttorneyadvising thatthe following claims have been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool: Michael Dressler for property damage; Optum on behalf of its Client,Auto Owners I ns Company/Jo Witterholt Weigel, for property damage;Amy Ressler for property damage. SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description Type ICAP Referral Supporting Documentation Dubuque THE CITY OF � w�A�eriea ci�y DuB E ,��r<<..,�,..� ; � � ► � � Maste iece on the Mississi i zoo�•Zoiz�zois rP pP zoi�*Zoi9 TRACEY STECKLEIN �i`D PARALEGAL •�� MEMO To: Mayor Roy D. Buol and Members of the City Council DATE: December 16, 2020 RE: Claim Against the City of Dubuque filed by Optum, on behalf of its Client, Auto Owners Ins Company/ Jo Witterholt Weigel Claimant Date of Claim Date of Loss Nature of Claim Optum/ 12/14/20 05/02/20 Property Damage Auto Owners Ins. Co. Jo Witterholt Weigel This is a subrogation claim filed by Optum on behalf of its client, Auto Owners Ins Company(AOS), and AOS' insured/claimant Jo Witterholt-Weigel. The claim alleges that a city sewer line backed up into claimant's basement at 2035 Admiral Street. A claim regarding this same incident was filed by Joann Witterholt-Weigel on 05/11/20 and was settled for $1,000. This claim has been referred to the lowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager John Klostermann, Public Works Director Optum OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA I SUITE 330, HARBOR�/IEW PLACE, 3O0 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563)583-4113/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org j