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Claim by Jaylin Inc. Copyrig hted April 5, 2021 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: Clyde Kay for vehicle damage, Jaylin I nc. for property damage. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Claim by Clyde Kay Supporting Documentation Claim by Jaylin Inc. Supporting Documentation Confidential This communication and any attachments may contain information which is confidential and prirrileged 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 tha� any re�iew, disclosure, dissemination, distribution or copying of its contents is prohibi#ed. Please notify Ci#y of Dubuque immediately by telephone at (563}-589-4120 of your receipt of #h�se 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} MedicallHealth Information � �ersonnetlDisciplinary �n�ormafiion 4) Bank Account Informatian 5) Financiallnformation 6) Credit Card Numbers lf any documentat�on you desire �o submit to the C�ty of Dubuque contains any of the items above #his co�er sheet must be attached directly to the confidentia! in#ormation and indicate the type of informatian that is includ�d. I, �, a � �G �� , hereby certify �hat the attached documen#s include the f wing protected information: Social Security Number(s) Bank Acco�ar�t In#ormation Medical/Health Information Financia{ Information PersonnellDisciplinary Infiormation Credit Carci Number(s) I understand tha� this information may be distributed within the City organiza#ion or to agents of the City for processing and I hereby authorize the CEty to act accordingly taEcing all precautions to protect my in#ormation from unnecessary distributipn. .. � -� 3�' �IJ � " Si a�ure Date �� L�9�.I , , �7l�lo,��e�m�,n� +�LA1M AC��►INST' TNIE �IT`t�' t�� DtJ�31JC�l,�E, 1t�11VA A, 5,�,��- This wr�t��n_r�p�ort �const�fiut�s y�ur ��aim_�gainst the +�ity a�C�ubuque, I+awa. �`cru shcruld ___ _. _ _ cr�mp[�te this form in �ull and att�ch any�dditi�nal informatic�n that suppflrt� your cl�irr�. � The Claim must b� filed with fh� Ci#y Ct�rtc at City Hall, �U W; '13�" St,, �ubuque, IA �2C}01. Et � will then b� referred by th� City Coun�il t� the appropriat� departm�nt fr�r investigation. C)nce that investigation is completed, a r�pc�rt and recomm�nd�ti�n wiil k�e submitt�d to the �; City Cc�un�il. You wi11 be prc�vided with a �c►py of that rept�rt�nd rect�mmendafiia�►� '� a I� THE FINAL. C}EC#�lt�� {�N ALL» �CLAIM� 15 MAUE BY TH� GtTY CC�UNCiL. Nt� E�4t1P�t�Y'�E tJF � THE �GITY CtF C7iJBU�Gi11E MAS T�I1� AUTHt'�F�tTY TCy MAKE A�IY RE}�FiE�ENTA.TIC3N TC} YC3U � A� Tt3 WHETH�Fi YC}UR �LAIM W�l�l� C�R WILL NC�T BE PAI�. j � '�. �larne of Claimant, ��... ��,. � � �....... �� __.,.__ _ �. _ _ _ _. . � ri_. �,,�v' _�. �..�__. �� `: _._ _ _....__ _._.. . _.._._ _._. ; _._.._�._.��„�....__ ... City: ��.�"'� �., State; _��,� Z��; ��..�....,. � �. i'+el�ph�r�+� Nu�rrb�r: ..��.� �- ,�� °.,` � �.� �� g �.� �� 4�. �ate c��acident: �.-�`�` �� "�� 11 � �. Time +�f Inci�lent: �� '�� , 6. L4C�tli31'1 �C?�I1iGlt�E:11'�{BL'SS�iBC1�IC}: �:� �� .�« �t�c� `��,..��.. .� ��.�. ?. t7ESCFtIBE ACCIdENT t�R �?+C�UI�I�EN�� THAT CAU�EE� tNJURY QR CTAIVIAt��. �C�ive � full detai)s upon which yr�u base your cl�im. If a City employ�e v�ras invc�l�r�d, ±give the �i +�mployee's name.� , J1 / � � �s-��- �.. �3"�" Gc.�� ,,��.. �7�,.�... �' f.�..�--� .ii,�..,t �` � 1� �"� s �,, "� �e�.�... � �� C� �, t?,� '�. � ��+��' ��j'� 8. Wh�t were wea#her canditions like? �- ��'�. � �` �: j 9. Give name and address c�f�ny wit�esses: ��`� � �� " �'c� ��t�f�.y� � � � �&�� 1 Ct. I��d pol�ce �nvestigate. {Ifi so, g�ve narnes of aff�cers.)�� t ��.�� 1��° � ; 19. Was anyvne injured? �lf�c�, give n�m�s, addresses, and �xt�nt of�nj�ri�s}. 12, 1N�s any darr�age �I�ane to property'? �tfi s�a, d�scribe property ��d the exten# of � _,_ _._ damages. _ A�fach e�timat�� af da�mage� �r des+cribe b��is f�r �s�c�rtaining ext�r�t of '� damage.} �� . �� .� �`' ��..�``.c� ��...� = t�- � _ � _ � �, ,� , � 13. W'F�at ofiher damages dt� y�r� �lairn, if�ny? ,,�� "� .� � � �� C� ��,� i �� ' ; °14. N�ve you b�en �ompensat�:�! fo� any part �r �11 of yc�ur cl�im by �ny Nn�urance � c�mpany? _ (If sc�, giv� n�me and at�dress of insur�nc� cc�rr�p�ny ar�d �r�c�unt p�id.� _ ___ _ ! __.. _. __..,_. ,.�,...�.._, _ ._...___,.. __._ __...___._._.._................__........ _ __.._..._.....__..........__...._........___.._...__.......___.........__............... i _......._._.........___._ ........ _.........._._.._.................._...._ _ _....._. _ ; _..__......_.____. ,I � � 15. Wh�at amc�unt do y �r claim from t�� it� of C3uk�u�ue? �` .�� . , � ��. �� .�.� {.� �� i� ii 'i�. 1Nhy� do yc�u cl�im th� �ify +�f ubuqu is r�spc�n ible? li Y' �.,s"�� - � �-- t�t.�v�-�s �'� ��°'� � u.�"``r�. G�,� c� I} �I '17. Hav� y�u ma+de �ny cl�irn ag�ins�anyc� � eise for dama��s as a result of thi� in�id�r�t? '�� {if yes, ��ve n�me�nd addre��.� �� '18. 1f the ans�r�er to �u��fiic�n 17 �s y�s, h�ve you receiv+�d any paym�n� fraam �Mat s�,urce, � and ifi sa, in what am�un$? �i � Dated at Dubuqu�, fow�this �� day c�f �� "" , 20�. I � � {Signature} : ��, �� ,� (Print Name} �� '°s ��--� �y:� :.�._ � �� : � �° �� t�-�: '.,_ �{�; � °� .� t_� �;;` `-�_.� � C.r� i� .`":� ^�-.�, � �,� � (1Rev. �198} ,T,�' �� :� � �? ; �_ .,�W., l._. f;,, �� Filing a Claim When Shoe�ld � �ile a Clafm? !f you have sustain�d an fnjury ar damage for►nihich yau belie�e the City or one of its employess is responsible,yau may tile a olaim agatnst fhe City, Hnw Da I Request a Claim Form? 1n order ta obtain a clatm form, ptease contaGt or�isit one vf the following Cify of#ices: Citv CEerk's L7ffice Gitv Aitorne�'s Ofiice Cify Wall Harbor View Ptace,Sfe.330 50 W. 1 Sth St. 300 Main St. bubut(ue,IA S20E)1 �ubuque, IA 52d01 683.589.A120 563.5$3.4113 i Can I Send in Adcliti�nal lnformation w�th t�e Clatm Fr�rtt�7 Yes. If is recommer�cted thaf ycu send in as muah infor►�atian as possibfs wfth your c1aEm iarrr� in crd�r to expedite the in�estigation of ihe�cEairn.Thfs �nc�udes, but is not timifed to, estimates, �eceipfs,medical bilfs, pictures and any Qther in3vrm�fia�you feet enay be relevani to your a�aim. It Is also recammended that you send in copies cf Ihese What Happ�ns Aft+�r I Fife My Claitr�7 Onc�a clairrt has 6een rece��d�ncf f1e-stamped by the City Gl�rk, it is forwarded to the City Aftorney`s 4f�ce for in�esfigatinn,Cl�ima Invol+�ing p�rsonai injury or substantial praperty damag�will be forwarded to the Cify's claims ager�oy for i�vesttgatf�n_You w�li receive a lefler frnrr'�the C€ly Attor�tay's Of�ce indicating thak your clalrr�F►as b�en forwarded ta fhe claims agency.7his let#erwill afso contain the ct�irrjs agency's contaet lnformatlnn. A c[air�s adjuster wlll lhen cant�ak you regarding your ciaim.At that paFnt,any questtons regarding your claEm shauld be adsiressed tp t[�e cfaims adjwster,Ai[other Clairris wili be Farwarded tv the ap�ropriats CIty department for tnvesEigatior�.Afier speaking with emplaye�s and consulting department records,the depa�tm�nt manager 1 supervisor wifl make a recammer�datiort as to whether the cEairn shauld be approved or denled. Basec3 on that ir�t`orma#ion,lhe City Atiorney wEff then make a recommendatirsn to t[�e Cify Council as to whether th� cEa1m shnulcl be a�pro►�ed or denied, if the City Ativrney recommends fhat the cla�m be cienlsd,you wltl recei�e a copy o#ihe depar#ment manager/su�srvisar`s repo�t along with#he City Attorn�y's rep4rt tv fhe City Gouncil. tf ihe Clty Attamey recommencfs that the cla9m be appraved,yot��nfill 1'eCeIv�the City AttvrCtey's raport ta the Ci1y Caunoli as�elE as a releas�fnrm#e be signed a�d r�tumed tc the Clty Attorney`s Oi`fice.These ars oniy recammendatlons. li!s Irnpartant to ttnt�that the final decision an al)clattn5 is made by the Cliy Counall. No emptoyee of#he Gity has the autharity ta make arty representation to you a€s ia whe�her your cialm wfil or v�rill nnt be p�id. If the City Cour�c�l approves the cfalm for payrrtent at tts Cify Ccsuncil meetEng,a check wil)be mafled to you proVfded the City AtfoYrtiey's Ofiica has received yaur signed retaase form. What if My Claitn is �enled by the C[ty Caunc117 The City Ccuncil rnakes its deterntlrtaflort ai City 6ounoil meetings,which are E�eid the frst and t�ird Mond�y of each r�ortth.We rer.omrnend writing� feife�fo tha City Council indicatirtg why your claim shtruld not be denied a�d any additfonal Informatian tY�st you�ave fn supporf your cialm. If is not necessary#o appeal tFse Clty Atforney's recammendation[or denlat ot yaur claim befare the City Cduncit makes its determinatior�,haw�ver,you r'�ay do so.You are in�ifed io attend the City Councfl meeting when your claim will b$decEcEed; however,your attendance is no#mandatary and you sfill ha�e ihe righf to appeal ihe C9ty Councll's deciafon any time afler it has beers made. ]f your clairrs ar appeal ia denled,yau have ihe aptlan of f31ing a lawsutt in a co�rrt of appropriate jurisdiciinn. How L.ong Dn I Have t�Wait Before my Claim €s Resolrred7 The length of time it takea ta Inv�stfgate and resot�e a claEm depends largely on the nature o�the claim and ihe amairnt of damagr�s involved.Soms atsims may taka a few�r�eks tcs eesatve,whtle nit�ers may take langer. If yau wish ia check nt1 the status of your claim ar ifi yau have any questior�s or cnncems�bouf#he process,can#aai the Cily Attorrtey's�ffia�at 563_583_q113. You may�ile a claim at any��ms. However,if yaur clairr�is dented by the City Cauncii and you wish to iile a lawsuEt, yau shauid be aware that state law rnay limit the t[me In w�ich ta fie a lawsuit. Fi�ing a C1aim Vllhen shou�d l file a claim? fF you have sustai�ed an injury or persona! property damage for which you believe the City or one of its employees is responsible, you may file a claim against the City. How do I request a claim form? �a-er��#a-ebtai�-a claim form, please contact or visit one of the follawing City_�fficesr City Clerk's Office City Attorney's Office City Ha11 Harbor Vew Place, Ste. 330 50 W. 13th St. 300 Main St. Dubuq�ae, IA 52001 Dubuque, IA 52001 563.589.4120 553.583.4113 Can I send in additionaf information with the c�a�m form? Yes. It is recommended tha�you send in as much information as possible with your claim form in order to expedit�the in�estigation of the claim. This includes, but is not limifed to, estimates, receipts, medical bills, pictures and any ather infarmation you feel may be relevant ta your claim. It is also recammended that yau send in copies of these items and keep the originals #or your r�cords. What happens after I file my claim? Once a claim has been received and file-stamped by the City Clerk, it is forwarded to the City Attorney's Office for in�estigation. Claims involving personaf injury or substa�tial property damage will be farwarded to the City's claims agency for in�estigation. You will receive a letter from the City Attorney's Office indicating that y�ur claim �as been forwarded to the claims agency. This letter will also contain the claims agency`s contact information. A claims adjuster will then contact yau regarding your claim. Afi that point, any questions regarding your claim shauld be addressed t�the cfaims adjuster. All other claims will be forwarded to the appropriate City department far in�estigation. After speawng with employees and consulting departmen#records, the deparkment manager 1 supervisor will make a recommendation as to whether the claim should be appro�ed or denied. Based on that information, the City Attorney will then make a recommendation to t�e Citv Council as to _ _ , Select Languagg � wf�e�.her the claim should be appro�ed ar den�ed. If the City Attorney recommends that the claim be denied, you will receive a copy af the department manager 1 supervisar's repo�E along with the City Attorney's report to the City Council. If the City Attor�ey recommends that the claim be approved, you wiil receive�he City Attorney's re�ort ta the City Council as wel[ as a release form to be signed and returned to the City Attorney's Office. These are only recamm�ndations. It is impartant to note that the final decision on a!f claims is made by the City Council. No employee of the City has the autharity to malce any represen�ation to you as to whe#her your claim will or will not be paid. ff the City Council appraves the claim for payment at its City Council meeting, a check will be mailed to you pro�ided the City Attorney's Office has received yaur signed release#orm. What if my c�aim is denied by the City Council? The City Council makes its determination at City Council rrEeetings, which are held the first and third Nbnday of each mon#h. We recommend writing a letter fa the City Council indicating why your claim should not be denied and any additional information#hat you have�o support yaur claim. It is not r�ecessary to appeal the City Attorney`s recommendation for denial o#your claim before the City Council makes its determination, howe�er, yau may do so. You are in�it�d to attend th� City Council meeting when your claim will be decided; however, your attendance is not manda#ory and you st9ll ha�e the rEght ta appeal the City CounciPs decisian any time after it has been made, If your claim or appeal is denied, you have the aption of filing a lawsuit in a court of apprapriate jurisdictior�. How long do I have to wait before my claim is resolved? The length of time if takes to in�estigate and resol�e a claim depends largely on the nature of the claim and the amount of damages �nWoi�e�. Same claEms may take a few weeks to resolve, while others may take longer. �f you wish ta check or�t�e stat�as of your claim or if you have any questions or cancerns abaut the process, contact the City Attorney's Office at 563.583.4113. How long do I ha�e to file a claim? You may file a claim at any time. Howe�er, if yaur claim is denied by the City Council and you wish to file a lawsuifi, you should be aware that state law may limit the time in which to file a lawsuit. Select Language � C� Go�ernment Websites by CivicPlusO Select Language � � � lnvoice D[1B�l�U ONIPANY D�t� 3/26/2021 210 Cedar Cross Rd. �nvoice 16955 Dubuque, IA 52003 PH 563.5$2.1691 1'.0.No. � www.dubuquesign.com `Bi11 To _ _ _ ; �Jaylin Real Estate � i .___..._.__......... ....... .____. _....� ;343.3 Hillcrest Ad ' — ��Dub�u�que; IA 52042 '� — i Due Date i i E � �� ._.._.._._�..�._._._.... .... ....._� i � ` 4I1012�021 ' �. .....me_. �._ _---. _.____........�.. __.w_._..M._w___ _ —. ;... _. __... � Qty. � Description � Amount � _ . _ ..._ . . . . _. � ... _ __ ... . . . ._ _...._._ _ �Service Calls:03/19/21 and 03/29/21 � 770.00T; -- � Labor to repair freestanding sign that was hit by truck.Labor includes(2)installers,(1)truck. Removed sign I face ar�d re-secured welds and put sign in correct place. Replace all la�nps and(2}ballasts in sign.Tested and � t � �all working properly at time of service. i � 3 ' i l 2'',F96 T 12 C W/I-TO 83.04T s � E 1 �RSS696AT 12QvRSS Allansan Ballast 4-61amp 3U-48ft ; 136.16T� � 1 'R5S496 BALLAST KIT � 1 I 1.87T�' ; ; i _.___....�__._ ___w.____._ _ _._,.._._._____.._.______ _� ...,_....__.. __....,__�___.... .,__ -------_.. ..... _.�_....�____..... _ W. _._�. __ .._.. _ . ,. �Sales Tax(7.0%} ��.o� ` THANK YOU FOR CH�451NG F Total $1,L7S.14- _ _ DU'BU�[! �� DMPANY Paym��ts A�p��ed �o.�� . :. .. -.M . _ . Balance Due $1,178.14 Please prcy fram this r'nvoice;you wilC not reeeive a statement. Pnyments not receivecl 6y dzre ciate are subject to finarrce chc�rges of 1.5%per month(18%per annaem) 1643�9 NRME SHIPTO L�UY� i AppRES5 ADDRESS �`� � �(�C u-� B' �� CITY,STATE,ZIP ClTY,STATE,ZIP ��SvC'S �r OR�EH NUMBER �EPARTMENT SALESPERSON WHEN SHIP TERMS HOW SH{P �ATE ------- --..-------- ----- - ----7-- . __/ QUANTITY DESCRIPTION PR10E AMOl1NT 04 � � ►�y � � c �c'6 �r� ��_ ��t r.�.�E._f L r .�r —�-5-�.�ssUt�'��.�,C��t/��L �.��2� �� y�� !�UwJ /'gw-� C `� � � �� - � P�'�C��c -� �l�C� ��C_o_� C �r� _ -- -_ -_d�r _ � a , �� i � -��. � � BUY�R: � adems� KEEP THIS SLiP FOR REFER�NCE "-12 8,o0 Copyrig hted April 5, 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 forthe lowa Communities Assurance Pool: Clyde Kay for vehicle damage, Jaylin I nc. for property damage. SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description Type ICAP Referral Supporting Documentation THE C[TY OF Du� E � � � o � A H � Q � Masterpiece on the Mississippi JONI MEDINGER LEGAL ADMINISTRATIVE ASSISTANT To: Mayor Roy D. Buol and Members of the City Council DATE: 3/31/2021 RE: Claim Against the City of Dubuque by Jaylin Inc. Claimant Date of Claim Date of Incident Nature of Claim Jaylin Inc. 3/30/2021 3/17/2021 Property Damage This is a claim in which claimant alleges claimant's property was damaged by a City garbage truck. 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 Jaylin Inc. OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)589-4113/Fax (563)583-1040/EMai� jmedinge@cityofdubuque.org