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Claim by Allyssa KrierCopyrighted May 3, 2021 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUMMARY: Andy Bradley for vehicle damage; Allyssa Krier for vehicle damage. SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney DISPOSITION: ATTACHMENTS: Description Type Claim by Andy Bradley Supporting Documentation Claim by Allyssa Krier Supporting Documentation 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. I, JI o- , hereby certify that the attached documents include t e following protected information: Social Security Number(s) Bank Account Information Medical/Health Information Financial Information Personnel/Disciplinary Information Credit Card Number(s) 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. �1.2-� J"Xj Signat Date MV(YU L,god CLAIM AGAINST THE CITY OF DUBUQUE, IOWA R. siec e-,n 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. 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 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: 2. Address: ,� l�a�-�t�� City: 64 U0_ State: fobAo, Zip: �5o 3. Telephone Number: 4. Date of Incident: /J 5. Time of Incident: JJ I. 13,� 6. Location of Incident (Be specific): �11 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.) W `' 6 B ` 00,0 Oja)X4�)�Lu 8. What were welather conditions like? 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) Q�� Cc C1A TCk I, 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). OP,0, 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.) 0111-1101. W�Fffmsl" 13. What other damages do you claim, if any? 9 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.) 15. What anpu,nt do you claim from the City of Dubuque? 16. Why do you claim the City of Dubuque is responsible? ,✓X No -s `ai-nn�a® r� rsn 5�� Qt �.a 6,o s`(' n��e r✓ls�o 17. Have you made any claim against anyone 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? Dated at Dubuque, Iowa this day of fir; , 2021. (Signature) 1k r; D (— (Print Name) (Rev. 5/18) �! Yi 3 < C? (.I._. j,-o% ., Driver Information Exchange Report Ij DUBUQUE POLICE DEPARTMENT (563) 589-4410 Driver's Name - Last First Middle Suffix Age Gender U ODOBASIC �ZLATKO, �59 MALE N Address city State- Zip Home/Coll Phone Number 1 949 KERPER BLVD DUBUQUE IA 52001 1(563) 5894266 T License Number Class State lRestrictions �B Insurance Co. Name Insurance Co, Phone # lEnclorser- 4610 IOWA COMMUNITY ASSURANCE P (800) 383-0116 001YES Owner Company Name CITY OF DUBUQUE Insurance Policy# Owner's Name - Last First Middle Suffix Address city city State Zip Vehicle Configuration 50 W 13TH ST -1—y--r �IA 52001 24 I VIN No, IMake Model Style Color 15GGB271XB1179463 12011 GILL �TRANSIT BUS BUS #2683 GRN License Plate # State Year 1 most iDamaged Area Approximate Cost to Repair or Replace 118158 IA 12 - FRONT MIDDLE I $0.00 Driver's Narne - Last First 1ALLYSSA Middle Suffix Age Gender U KRIER IMARIE 29 FEMALE N Address city 7 9ti te Zip Home/Cell Phone Number 1509 MOUNT PLEASANT ST DUBUQUE PLEASANT — — —7 IIA 52001 (563) 320.7926 T License CDL? Driver's License Number Class State Endo is or 11 Insurance Co. Name Insurance Co. Phone NO 77AN7717 C IA PROGRESSIVE (608) 723-6441 u" Owner Company Name Insurance Policy# 940054070 Owner's Name - Last First Middle — Suffix KRIER ALLYSSA IMARIE Address city State Zip Vehicle Configuration 1509 MOUNT PLEASANT ST DUBUQUE �IA 52001 03 VIN No. Year Make Model Style Color 1C4RDJDG9HC737328 2017 DODGE-DODG DURRAINGO UT WHII License Plate # State Year 107 Most Damaged Area Approximate Cost to Repair or Replace KAM060 IA 2021 - REAR DRIVER SIDE CORNER $2,000.00 County Accide it occurred within corporate limits of (city) DUBUQUE-31 �DUBUQUE _ 2100 Literal Description US 201DODGE ST MEASURING 458 FEET EAST FROM US 20/DODGE ST AND DEVON DR X-Coordinate Y-Coordinate 00689036 04706884 If If accident occurred outside of city Direction i.n C,ty��70or Nearest City Route (Cardinal) show general vacinity: of Travel Direction On Road, Street, or Highway: At Intersection with: Distance Direction I Distance Direction Milepost Number and of Or Definable intersection, bridge, or railroad crossing Officer Badge o. Law Enforcement Case Number I Date of Accident ITime of Accident I 2 E �CER GARY PAPS - 1 1 1-001803 4 03/16/2021 118:36 Hrs. Customer: KRIER, ALLYSSA Insured: KRIER, ALLYSSA Type of Loss: Point of Impact: Owner. KRIER, ALLYSSA (563) 320-7926 Business TURPIN DODGE CHRYSLER JEEP Workfile ID: 7ac7350f RAM PartsShare: 6cZ823 tfortmann@turpindodge.com Federal ID: 20-2360000 90 JOHN F. KENNEDY RD., DUBUQUE, 1A 52002 Phone: (563) 583-5781 FAX: (563) 556-6928 Preliminary Estimate Policy #: Date of Loss: Inspection Locatiom TURPIN DODGE CHRYSLER JEEP RAM 90 JOHN F. KENNEDY RD. DUBUQUE, IA 52002 Repair Facility (563) 583-5781 Day VEHICLE 2017 DODG Durango GT AWD 4D UTV 6-3.6L Gasoline Sequential MPI VIN: IC4RDJDG9HC737328 License: State: TRANSMISSION Automatic Transmission 4 Wheel Drive POWER Power Steering Power Brakes Power Windows Power Locks Power Mirrors Heated Mirrors Power Driver Seat Power Passenger Seat Memory Package DECOR Dual Mirrors Privacy Glass Console/Storage Overhead Console Wood Interior Trim Interior Color: Exterior Color. Production Date: CONVENIENCE Air Conditioning Intermittent Wipers Tilt Wheel Cruise Control Pear Defogger Keyless Entry Alarm Message Center Steering Wheel Touch Controls Rear Window Wiper Telescopic Wheel Heated Steering Wheel Climate Control Dual Air Condition Backup Camera Parking Sensors Remote Starter Home Link Job Number: Claim #: Days to Repair: 0 Insurance Company: Mileage In: Vehicle Out: Mileage Out: Condition: Job #: RADIO Reclining/Lounge Seats AM Radio Leather Seats FM Radio Heated Seats Stereo Rear Heated Seats Search/Seek 3rd Row Seat Auxiliary Audio Connection WHEELS Satellite Radio 20" Or Larger Wheels SAFETY PAINT Drivers Side Air Bag Clear Coat Paint Passenger Ali- Bag OTHER Anti -Lock Brakes (4) Fog Lamps 4 Wheel Disc Brakes Rear Spoiler Traction Control Signal Integrated Mirrors Stability Control California Emissions Front Side Impact Air Bags TRUCK Head/Curtain Air Bags Rear Step Bumper Hands Free Device Power Trunk/Liftgate SEATS Bucket Seats 4/14/2021 11:36:47 AM 094524 Page 1 Preliminary Estimate Customer: KRIER, ALLYSSA Sob Number: 2017 DODG Durango GT AWD Q UTV 6-3.61- Gasoline Sequential MPI Line Oper Description Part Number Qty Extended Labor Paint Price I LIFT GATE 2 Rpr Lift gate w/o SSV 4_5 2.2 3 Add for Clear Coat 0,9 4 R&I Upper trim black 0.3 5 R&I Lift gate trim black 0.5 6 REAR LAMPS 7 Repl LT Tail lamp assy 68272127AB 1 470.00 03 8 Repl Backup lamp assy w/rear camera 68453659AA 1 1,125,00 0.6 9 REAR BUMPER to O/H rear bumper 2.8 11 Pep] Bumper cover w/reverse sensor 68304551AA 1 519.00 Incl. 2A w/o blind spot detection 12 Add for Clear Coat 1.0 13 Add for bind spot sen M 0.2 14 Add for reverse sens M 0.4 15 Repl Lower cover w/dual exhaust, w/o 6DQ80TZZAA 1. 287.00 Ind. 1.8 chrome accent 16 Add for Clear Coat 0.7 17 Repl Step pad 5113690AA 1 77.50 0.3 18 # HAZARDOUS WASTE 1 5.00 T 19 # CAR COVER 1 5.00 T 20 # NIB AND BUFF I 1.0 21 # flex additive 1 15.00 SUBTOTALS 2,503.50 10.9 9.0 ESTIMATE TOTALS Category Basis iial;e Cost Parts Body Labor Paint Labor Paint Supplies Miscellaneous 10.9 hrs 9.0 hrs 9,0 hrs @ @ @ $ 66.00 /hr $ 66.00 /hr $ 45.00 /hr 2,49150 719.40 594,00 405.00 10.00 Subtotal 4,221.90 Sales Tax $ 4,221.90 @ 7.0000% 295.53 Grand Total 4,517.43 Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 4,517.43 4/14/202111:36:47 AM 094524 Page 2 City of Dubuque City Council Meeting Consent Items # 3. Copyrighted May 3, 2021 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: Andy Bradley for vehicle damage; Allyssa Krier for vehicle damage. SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description I CAP Referral Type Supporting Documentation THE CITY OF DUB E N N D H a Masterpiece on the Mississippi JONI MEDINGER LEGAL ADMINISTRATIVE ASSISTANT To: Mayor Roy D. Buol and Members of the City Council DATE: 4/26/2021 RE: Claim Against the City of Dubuque by [NAME] Claimant Date of Claim Date of Incident Nature of Claim Allyssa Krier 4/14/2021 3/16/2021 Vehicle Damage This is a claim in which claimant alleges claimant's vehicle was damaged after being struck by a City bus. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager Russ Stecklein, Interim Director of Dubuque Transportation Services Allyssa Krier OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 589-4113 / FAX (563) 583-1040 / EMAIL jmedinge@cityofdubuque.org