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Claim by Jordan Koehler Copyrighted January 19, 2021 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: Jayne David for personal injury; Shane and April Hanson for property damage; Jordan Koehler for vehicle damage; Nathan and Amanda Salzmann for property damage; Becky Wolf and Chuck Minnick for property damage. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Claim by Jayne David Supporting Documentation Claim by Shane and April Hanson Supporting Documentation Claim by Jordan Koehler Supporting Documentation Claim by Nathan and Amanda Salzmann Supporting Documentation Claim by Becky Wolf and Chuck Minnick Supporting Documentation �� , L�� CLAIM AGAINST THE CITY OF DUBUQUE, IOWA `� �`�°s�"�"`�°�°� �. �,,��- 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. � i The Claim must be filed with the City Clerk at City Hall, 50 W. 13t" St., Dubuque, IA 52001. It I� will then be referred by the City Council to the appropriate department for investigation. j 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. �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 �'II AS TO WHETHER YOUR CLAIM WlLL OR WILL NOT BE PAID. ,i 'i. �ia�r� �� Claimant: �o�0�h �41�X' �'! GV 5 ,�� QI. � 2. Address: Z �� il City: ��/1,�,. State: S� Zip: '52�0� '' �� 3. Telephone Number: 30� -31 ( " Z2�� ,� 4. Date of Incident: �'Z �Z �d '� I 5. Time of Incident: (�'D 9 0�°vt �I ii 6. Location of Incident (Be specific): _� LaWutX' � ��n�4Vt ��. Du�r� 1�Ct0Y'0� ��"• i 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED IfVJURY OR DAM/AGE. (Give full details upon which you base your claim. If a City employee was invoBved, give the employee's name.) 1 �a�anrod �aSa�e�ri In��- � w�N► �a�k-�-d C�r u�i1�. sroW �1 ov� 8. What were weather conditions like? __ Sll�6�,lv► Yb�OI(�S 9. Give name and address of any witnesses: VP �� 10. Did police investigate? (If so, give names of officers.) ' ��-pU�-O�'� ��O�S h��V1wS�"G � � � 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � �� „ , � �I � � 1 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.) i doc,u.m►�.�' for � �- � daw� c o�r. �� a � 13. What other damages do you claim, if any? V1��. f I � � ,; '��. H�� y�u been compensated for any part or all of your claim by any insurance I company? (If so, give name and address of in�ur��ce corr�p�any �nd a�nour�t paid.) ycs ,�c. �. re�v�lnw�r�,►d o� �iu�' �'2S� dcdu�i hte. '; 15. What amount do you claim from the City of Dubuque? � �24� � 16. Why do you claim the City of Dubuque is responsible? � W�� o� r 17. Have you made any claim against anyone else for damages as a result of this incident? � (if yes, give name and address.) �� l 18. If the answer to Question 17 is yes, have you received any payment from that source, C and if so, in what amount? f v�/a 5�r- I Dated at Dubuque, lowa this day of 5� r v, 20 Zf .. ; � I ; (Signature) i C�) �' � o�� `'� (Print Name) 4,�,;�� .� �� -�; � CG� '� � _�,�:� �_� � �� C� Ct'� � �.,:r � � � � �� II Cj �y � (Rev. 5/18) � .�- I Copyrighted January 19, 2021 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: Jayne David for personal injury; Jordan Koehlerfor property damage; Nathan and Amanda Salzmann for property damage; Becky Wolf and Chuck Minnick for property damage. SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description Type ICAP Referral Supporting Documentation THE CITY OF DUB E MEMORANDUM Masferpiece on the Mississippi JENNYMESSER PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: January 12, 2021 RE: Claim Against the City of Dubuque by Jordan Koehler Claimant Date of Claim Date of Loss Nature of Claim Jordan Koehler 01/05/2021 12/12/2020 Property Damage This is a claim in which claimant alleges vehicle, which was parked by corner of Ashton Place and Decorah Street, was struck by a City of Dubuque snow plow. 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 John Klostermann, Public Works Director Jordan Koehler OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR�/IEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563)589-4381 /F�c (563)583-1040/EMAi� jemesser@cityofdubuque.org