Claim by Kyle FitzGerald Copyrighted
April 19, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Kyle Fitzgerald for vehicle damage; Jenny Rouse for property damage;
Drew Waller for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Kyle Fitzgerald Supporting Documentation
Claim by Jenny Rouse Supporting Documentation
Claim by Drew Waller Supporting Documentation
ConfidentEal
This communicatian and any attachmenfis may contain infiormation which is confiden#iai
arid priv��eged by law and �s #�r #1�e �se of #�e designa#er� recipien#. If you are not the
intended rec,ipient, you are hereby notified that you have received this communication in I
error, and tha#any r�vi�w, disctosure, d�ssernination, distribution or copying of its contents
is prohibited. Please notify Ci#y af Dubu���e immediate�y by tele�hone at (563}-589-4120 of '
your receipt of these items and destroy the corr�munication and any afitachments �
immediately. Furkher disctosure of this information may v�otate st�ate and federal �
restric�Eions�
Confidential inforrr�atian may include the fotEow'rng:
,
�) Soc'ra� Security Number(s}
2) Medic�llHealth infs�rmation
3) 1'ersc�nne11�3is�iplinary inf�rma�iar� i
4) Bank Accau�#1r�formation �
5) Financiallnformation '!
6) Credit Gard Numbers
t#any doc�r�aentati�n y�u desire to sub��t tca the �'it} t�f Dub�q�a� contains any of#he it�rr�s above �
this �over she�t must b� attacl�ed c�irec#i� #o �l�� caonfidentiai in�'ormation a�d indicatre the type o# I�
informatio�#hat is �n�cfuded. �I
�
�'�
' I
I, 1 , hereby eertify that the attached documents
inciud�the fol awing pcotected �nformation:
Social Security Number(s) Bank Acc�unt Informatior�
i
Medical/Health lnformation Financial Inform�t�on '
Person��lJfli��ip�i�ar� I�#orrraatit�r�� . . Cret�i�'Catd �iumber(s�
i u�derstar�d tha#this infarma#ior� r�ay be d�stribut�d e�ritt�ir� the Ci�r�rgan�zatic�n or t�agents of the
Gity far processing and 1 hereby authorize the Gity to act acccarding[y t�king a6l precautions fio
protect rny infarmation€rc►m unnecessary distribution.
��� �����
�
s��� � Qat�
_ _
u
�
: ����c�� �
r
GLArm AGAINST THE CrTY QF DUBUQUE, IOWA , �-��������''� �
�
This written r�port c�onstitutes your +claim against the Ci#y c�f Dubuque, lowa. You should
complete this form in#uil an� attach any addi#ionat inforrna�on th�t sup�or#s your claim.
The Clairr� must be filec!with the City Glerk at Ciiy Hai1, 5a W. "t3t�' St., pubuque, lA 520Q1. It i�
wili then be referred by fihe City Council to the apprapriate department for invest�gation. ,
Once that investigation is compteted, a report and recom�nendati4n witt be subm�tte�t �a tk�e
Ci�+y Co��c�1. Yau vv��i �ie prov�t�ed w�th� a�c��y�f#ha#�epor#�n�d recommendation. i
�
T�� FINAL DEC�S1�J�i fJN ALL CLA1�VtS 1S�VIA�E 8Y T�tE C1TY�t)UN�IL. �1tC? EMP�OYEE QF
THE GlTY C3F dUBUQt.tE H�4S THE AtlTNORtTY Tt3 M�1,KE R�tY F�EPRESENTATta11t �`t3 YOU
AS TQ WHETHER YC�UR CLAIM WILL C)R W[LL Nf?T BE PAIQ - - - �. .._�„�: :�:"���� ��--�� �'
� �y1e�i�zger�ci '
1. �l�rrte of�la�mant: �- 124c�Univ�rsiry Ave
2. Addres�. r�� , Dubuque,T�1�2Q�1 �ry �
�i - ,.�.� o �� - �
Il
City: state: �, zfp:�� V
i
3. '�'"�:ie�fi�����m�rer. __ ��� ��'�., �� ��
r
4. fl�te of lnc�+den#; ��� �,�� �� �-� ! I�
� �
I
5. 7'ime of lncident: �� �' �� �
+�. 1.�►cat�o�a fl�Inc�de�t(8e�p�eci#i+c); �� �� ���a�.� ..,��� �'�... � � �= t ��"`���'��
���-���
7', flES�R1�E ACCt�E�1T fl!� ���CllR�E�CE THAT CA�SEA ��JURY OR �AMAGE. (G�ve �
full d�#ails upon which you base your �1aim. !f a City ernpioyee w�s �t�volved, give #he j
e�l��0yee'S name.) �
� �
� � �a��� �
,
_ �' i�r,� �'��,�� Y ��,�� ���- � �-���` �a ��� 's�r,�����5��
� �
� �'§��*-s$�.. .�''�+....��k�!`/'°'��°� ��� r ��g��Z.��.�t ��°_.a.a' � y .�' � j �j ��� F ^"s'+ 8, �n, �;„ f�y,,..._ ('�g' � �_
8 1 a -^w�,.^' ���n. �.$F—s ��- f4�'a � q1f _'3t3 �'\ +,�`9����-��''"�`��"
�� �
8. V�Ma#were e�r�a#her c�nditic�ns I�ke? _°�";�� f��; ��.,�
� , t�
9. Give name�nd address of any witnesse�: , � ,�;,,���
�
10. �i� p�ai�ce f�avestigate? {�f s4, give names a�offcerse)
�.��~.�`��,= F^�--i4i�,F"-. ,�.�'� ��'� �' ���€ '�!��'������.
r �
� �
'19. UVa� any�n� ir�jured? (If so, give names, addresses, and extent of injuries),
���.
8
12. Was any damage done to property? (!f so, describe praperfiy and the extent of
damages. Attach estimates of damages or describe basis for ascertaining extent of
damage.)
,,-� s. � ,�� ,
�t��tt�,�'�� g�.�, �. f �� '. !\ % a�If� �G��' '� ,��� a � � ��`-,'`� � g� �
� - � E:
�`�
��� {,�.�� ¢; ����fi�`„
13. iN�at ot�er dama �'S tl+� �l1 ��+r'�it�li if an � f `� �
9 �• ���� _-�� , r
� __ �
i
14. Have you been compensa�ed f�ar any part or atl of your cfaim by any insurance �
campany? (1#ss�, g��r�e r�ac�e a�s�a�ddress o#�nsuranc�cc�m{�a�ay�nd arn�unt paid.)
� �
�`�-��
�
p
'(5. What amount do yuu claim frarri the City of Dubuque? � � �: ,� � �;
`��� `�:���� � � I1
� � � �� i
16. 1i�it�y��y�u c�a��#�Q�C�#�r�#����qu��s �s�a��asib�e? �I
�-„�„„,,.� r �- � ';
� � � �� ��A';-�`r'� �'��—``�`"�`�- li
� � t ��,� �
17d Have you made any claim a�ainst an�ene else�or dam�c�es �s�21 �'GSUI'�O$'��'t#S tMCfCC��flt? I�
(�f yes, give nam�and address.) �
�� �� �
18. 1f t�e an�wer t+a t�uest��n 1�' is �es, f�a�re �ou rece��red any payment firom that saurce,
and if so, in wvha#amount?
i
� ;
� �� � P
Dated at Dubuque, lowa this � day of �����. , 20���.
���
��"�`�'�,� �' �,��°_...�
�..;,f ,,��,r .-�:�' {S�gnature)
.��' ,�
�'
f¢ ,�- �;,� � � __� ,�s
�� �.
� " � p ,F �.,���/������� �� :� w...,,._1
�"��.."�� �--�- a �� _ � (Print Name) .�..�=, v� �o
r� =�- c .: :�� �-�-;
�" fC,� �w, ��—�Ai
i�i .,=_ �=
r-- �,' �`�_d
_�y Ci) 't��g. `w.:�
,. �.+ � ;;'�f
. " r,�, ��� �^��
(Rev. S/'t8) ;�; .,._ _.
.�
r- t' � f {'
� ,��� t � �^' 1 ,�
,,�A� - ..�/ ,�, -� � � �,; r €���: ��,
, L �
��.1`''w•�'." -s` , � ���,.,�� ,. � _9.;�..__ ��--' .
_ �
���, t�ri�er Inform�tion ��cc��ng� R��o�t "
QUBllQUE AOLI�E DEPARTMENT
_ (563)5&8-4410
Driver's Name-Last F��sf - I
Middle Suffix Age Gender �
U DEWELL CRTHERW� RNN � �61 FEMALE
� Address �
� '198 ALPIlJE S7 Ci� State Zip HomelCe{!Fhnne Number
DtiBUQUE IA 520t11-U000 {S02}8'19-8186
� CDL? Drlver's License lUumber Ciass 9tale Endorserroants Rss#rictions lnsurance Co.Nama
YES 437AR9756 g Insurance Go.Phone#
IA LP BEKM l4WA GflMMU�IITIES AS5Ui�4NC� (593)278-9400 !
�Q� Owner Company Name Insurarece Policy#
CI?'Y OF DUBUQUE " CERTtFICATE NQ:53
Owner's Name-Las# �irst Middle Suffnc
- Address
'` ���,13=��.� ������E State Zip VehicleCanfigueatidn
IA` 520U�1 �q
V!N Na. Year Make Model Siyle ` Colnr '
75Gi3E22'l521{190494 2i302 GILL 7�ANS1T 8�15 Lt�1lU 8t7� �FlAI i
License Plate# State Year Most Damaged Area � AAArosrimaie Casttv Repair nr R�p)ace ` �
NQ 02-F[iONY PRS3ENG�R SIf3E $2,DOQ.OQ
' Driver's Name-Last First Middfe Suffix Ag� Gsnder
;
�� �- .�-�
,. _ . �.._ �_.�- -._,-..:.�.,,,_.�_�- �
� Address . ,. - ;�_.._-�_-- _.�_ -
i . City Staks ZiP , f�ameiGeff Phane f+lumber . _ - �1�
T Ct317 � � {563)542-8867 � � � � 'I
Driuer's i.icense Number . Class State Endorsements Restric�ions lnsurance Co.Name I
lnsurance Co.Phone#
�Q� Ovdner Gampany Name Insurar�Ge Policy# : '
4wner's Name-Last First Middfe I�
FtTZGERl1LD . suffix �
KYLE GEOFFREY I
Address
12A�1 i3t�1t3tE12SiTY Ai�E [)U�lJQU� State Zip Vehicfe Conftgurakion I�
I�l 3200'I OU40 p� '
V!N No. Year Maka Model �
7FT8W3B'f3HED17912 2017 �t3RD-FC3R4 p3� ���� Color i
PK BLK ;�
l.icersse Plate� SYate Year Most�arna�ed Area
REttSE_ tA 2021 d9-MtDDLE CI�t{VEEt SIDE �t�ro�cimate Cost to Rep�ir or Replace
$50.D0 �
County Accident occurred wlthin c�srporate iimits of(cityj
DUBU4UE-31 DUBUQUE-�100 � � �� ��
Literel A�scriptfon Ij
I
BL�7FF ST tYl£ASl3Ft1�lG 23��'fET�DUTii FR{3iV]BlLi�F ST ANI}1fV'��TH ST I
X Coordinate Y-Coardinate
0069�1436 . 0+37fl89 S2
if accident occurred flutside af cityr Direction Nearest City
fimits shaw generaf vacinity: Qf RoLte(Cardinal)
Travel Direction
On Road,3treet,or Highway: At Entersection with_
DisEance Direction Distanee Direotion Milepost Number
and n# Or
DeSnabte intersectinn,bridge,ar r�iir�ad crassing
_ _ r - _ _
_ �_
Ilfficer 8adge No_ aw Enfr3rcement ase Numbxr Date af Actident Tome nf Accidant
O€P10ER t7YLAN DOERfiES $8 2Q2U-OD7468 'l1/10I202U 96:35 Hrs.
. �
_�,
�g
\
,�
,���
�
,�
�
.
.
Quote: 10221 �
• Phone (563)875-2409 Account• PR
FAX(563} 875-7482 Salesman: 000466
Tt�IIFf�ee '!-$$8-$75-2409 Date; 04/07/2021
3�3584 41d�Hawkeys Rd.
Dyersville, towa 52040 www.victoryfordon�ine.Com
Customer: 32059
FITZGERALD, KYLE GEOFFREY �
1240 UNIVERSITX AVE �
DUBUQUE IA 52{?01
Piion�: 5f3-542-�i8671553-542-6867 ',
Qt�,r part Number/Desc�ip�i.on I�ocati�n On Hand List Price Sa3.c� Price Total �
1 HC3Z176$3KA SaP fl 1588,45 1688.45 1688.45
MIRROR ASY - REAR VTEW '
1 �P�*��pR 75.00 75.00 75.00 `
CHARGE 'i
�
�
�
�
�
1
�
I;
�I
i�
�;
I,
II
�
�j
�
p
�
�I
�
�
Any w�rranties dn the prod�.�cts solci h�reby are th�se made by
Lhe manufacturar. The selier hereby sxpressly disclaims all
rrarranties, aitner expressed or i.mplied, inclaading any
rrarranty of inerchantabil_ty or fitness for a particul.ar
pur�Qse, and neither assazmes n�r authorizes any oth�r p�rsc�n
to assume for it any liabii_ty in connection ;�ith the saici
sale of said prociucts.
• ALL RET°:3RNS MUS'P BE MADE WITHIN 10 DA'IS AND SUBJECT Tt� 20 0
HANC3LING CHARGE.
• Id0 REFUtdDS ON EL�CTRICAI, PAIZTS OR SPECIAi ORDER PAR'S�.
• 1�LL RE3'URNED PARTS MUST BB IN L)RIGINAL SA?.EABL� PACKAGING.
Tatal Parts: 1763.45
Tax: 123.44
Signature. Quote Total: 1886.89
Printed: 04/07/2021 03:22:58 PM This a.s a quote. Quoted prices subject ta change, Page 1 of 1
Copyrighted
April 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: Kyle Fitzgerald for vehicle damage; Jenny Rouse for
property damage; Drew Waller for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description Type
ICAP Referral Supporting Documentation
THE CSTY OF
DuB E � � � o p � H a � �
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Roy D. Buol and
Members of the City Council
DATE: 4/14/2021
RE: Claim Against the City of Dubuque by Kyle Fitzgerald
Claimant Date of Claim Date of Incident Nature of Claim
Kyle Fitzgerald 3/1/2021 11/10/2020 Vehicle Damage
This is a claim in which claimant alleges claimant' vehicle was struck by a City bus.
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
Russ Stecklein, Interim Director of Dubuque Transportation Services
Kyle Fitzgerald
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