Claim by Joseph MoezCopyrighted
June 21, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Connor Amb rosy for vehicle damage and Joseph Moezforpersonal
injury.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Connor Ambrosy Supporting Documentation
Claim by Joseph Moez Supporting Documentation
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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. 13 th 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: Joseph Moez
2. Address: 4238 27th St
City:
Kenosha
3. Telephone Number:
262-909-5332
4. Date of Incident: 01/22/2020
5. Time of Incident: 7:30pm
State: W1
Zi p: 53144
6. Location of Incident (Be specific): Gazebo at Washington Park in Dubuque, Iowa
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.)
Visiting Dubuque and staying at the Redstone Inn & Suites. Walked around to explore the city and came across
Washington Park. Saw the gazebo. Sidewalks and gazebo floor were clear. Slipped on ice on the stairs.
8. What were weather conditions like? Cold, clear
9. Give name and address of any witnesses: Caroline Kelley 3113 Ruby Ave Racine, WI 53402
10. Did police investigate? (if so, give names of officers.)
Im
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Yes, Joseph Moez. 4238 27th St. Kenosha, W1 53144
I sustained a comminuted Weber type B fracture through the left distal fibula.
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.)
No
13. What other damages do you claim, if any? Medical expenses, lost wages, pain and suffering/loss
of body function
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.)
Yes, health insurance with UMR paid a portion of medical expenses, exact amount unknown
15. What amount do you claim from the City of Dubuque? TBD
16. Why do you claim the City of Dubuque is responsible? Failing to mitigate icy steps on gazebo.
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 20
qx�4' (Signature)
Joseph Moez (Print Name)
(Rev. 5/18)
M
City of Dubuque
City Council Meeting
Consent Items # 3.
Copyrighted
June 21, 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: Connor Ambrosy for vehicle damage; Joseph Moez for
personal injury.
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: 6/9/2021
RE: Claim Against the City of Dubuque by Joseph Moez
Claimant Date of Claim Date of Incident Nature of Claim
Joseph Moez 5/27/2021 1/22/2020 Personal Injury
This is a claim in which claimant alleges claimant injured his left leg after stepping on a
patch of ice causing him to fall.
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
John Klostermann, Public Works Director
Joseph Moez
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