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Claim by Douglas SpyrisonCity of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUMMARY: SUGGESTED DISPOSITION: ATTACHMENTS: Description Copyrighted July 6, 2021 Dustin McGonigle - Section 1983; J.B. Priest for property damage; Douglas Spyrison for property damage; Jane Thorne and Michael Thorne for vehicle damage; Settlement Agreement and Mutual Release of All Claims between HACAP / Operation New View and Gary Stelpflug/2G2, LLC. Suggested Disposition: Receive and File; Refer to City Attorney Claim by Dustin McGonigle Claim by J.B. Priest Claim by Douglas Spyrison Claim by Jane Thorne and Michael Thorne Settlement with Gary Stepflug and 2G2 Letter and Settlement Agreement Stepf lug and 2G2 Type Supporting Documentation Supporting Documentation Supporting Documentation Supporting Documentation Staff Memo 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 this cover sheet must be attached directly to the information that is included. City of Dubuque contains any of the items above confidential information and indicate the type of I, Douglas Spyrison , hereby certify that the attached documents include the following protected information: Social Security Number(s) Medical/Health Information Personnel/Disciplinary Information Bank Account Information Financial Information Credit Card Number(s) I 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. Signatur Date 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. 13th 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: Douglas Spyrison 2. Address: 1295 Grove Terrace City: Dubuque 3. Telephone Number: 563.580.3595 4. Date of Incident: 9/28/2020 5. Time of Incident: 4PM State: IA Zip: 52001 6. Location of Incident (Be specific): 459 Loras gas explosion breaking our windows at address above 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.) 459 Loras gas explosion breaking our windows at address above 8. What were weather conditions like? nice Fall day 9. Give name and address of any witnesses: Well documented by city and TH 10. Did police investigate? (If so, give names of officers.) multiple city staff on site of explosion 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). not applicable to us 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.) 3 windows suffered breakage in our home, Final billing for the repair was $1225.00 These were leaded glass windows raniiiraing ckillari ran^ir A 4th wooden casement widow had been repaired previously by the homeowner, no claim. 13. What other damages do you claim, if any? none 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.) West Bend Insurance, West Bend, WI (Friedman Insurance, agency) $500 15. What amount do you claim from the City of Dubuque? $725 from liable payer 16. Why do you claim the City of Dubuque is responsible? We understand the city is collecting and handling the claims for the liable payer. 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 9th day of June , 20 21 (Signature) 4( �// C S0/J (Print Name) r1 Cry' -J t U) Y �i (Rev.5/18) 0 .ate r...,. �� _ ;:�,,. ;�'' p � u� `� '.11��f- y���r .. o���.>i.,Gt 1� � ,I it l ifi 1I�N ®®II / _ 1 1.I. 6/18/2021 IMG_2826.jpg https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgxwLtkZxnbxCZswgxfBhVkTppbjr?projector=1 &messagePartld=0.1 1/1 6/18/2021 IMG_2828.jpg https://maiI.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgxwLtkZxnbxCZswgxfBhVkTppbjr?projector=1 &messagePartld=0.3 1/1 6/18/2021 IMG_2824.jpg https://mail.goog le.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgxwLtkZxnbwsWNdHtvlQmzsrKQbZ?projector=1 &messagePartld=0.3 1 /1 City of Dubuque City Council Meeting Consent Items # 3. Copyrighted July 6, 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: J.B. Priest for property damage, Douglas Spyrison for property 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: 6/29/2021 RE: Claim Against the City of Dubuque by Douglas Spyrison Claimant Date of Claim Date of Incident Nature of Claim Douglas Spyrison 6/9/2021 9/28/2020 Property Damage This is a claim in which claimant alleges claimant's windows were broken as a result of a September 2020 gas explosion on Loras Boulevard. 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 Alexis Steger, Housing & Community Development Director Douglas Spyrison 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