Claim by Jane Thorne and Michael ThorneCity 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
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.
I. Name of Claimant:
2. Address:
City' �'k' '� State: T2-
ZiP: _LI
3. Telephone Number: �OCf -
4. Date of Incident: U -:w _ -
5. Time of Incident:
6. Location of Incident (Be specific): Pr rv. `+
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.)
8. What were weather conditions like? Q Lop), , Q h 1,
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
it .an.a I _
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.)
Y
13. What other damages do you claim, if any? _0 t , r)Y
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 amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) ,
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
IC, cw 01,n-- lA I o e(Print Name)
(Rev. 5/18)
c;
`, Driver Information Exchange Report
DUBUQUE POLICE DEPARTMENT
(563)589-4410
U
Drivers Name- Last
First
Middle
Suffix
Ago
Gender
COOK
JENNY
LYNN
45
FEMALE
IN
Address City State Zip Home/Call Phone Number
I
7472 RADFORD RD ASBURY IA 52002.0000 (563) 451-3090
T
CDL? Driver's License Number Class State Endorsements Reshrictions Insumnce Co. Name Insurance Co. Phone It
001
766YY4053 C IA NONE B ICAP (563) 589-41"
Owner Company Name
insurance Policy #
ITY OF DUBUQUE
53
Owner's Name - Last
First
Middle
Suffix -
Address
50 W 13TH ST
DUBUQUE
StaIA
Zip Vehicle Configuration
52001 02te
VIN No.
Year
Make Model
We Color
3C6JR7DT1HG675507
2017
RAM RAM 1500ST
PK WHI
License Plate #
107280
State
Year
m
Most Damaged Area
Approximate Cost to Repair or Replace
IA
2099
09 - MIDDLE DRIVER SIDE
$200.00
U
Driver's Name- Last
First
Middle
Suffix
Age
Gender
RATCLIFF
JOHN
CHRISTIAN
23
MALE
N
1
Address City State Zip Home/Cell Phone Number
201 W 17TH ST APT Al DUBUQUE
T
IA 52001-0000 (760) 525-1959
C0 Drivor's License Number Class State Endorsements Restrictions fnsumnce Co.Name Insurance Cc Phone#
D02
NO 414AR4791 C IA NONE NONE AMERICAN FAMILY MUTUAL (309) 353-8700
Owner
Company Name Insurance Policy#
_ 129209611368FPPAJL
Owner's Name- Last
First
Middle Suffix
- -
RATCLIFF JOHN
CHRISTIAN
Address City
01 W 17TH ST APT All
State Zip
Vehicle Configuration
DUBUQUE
IA 520010000
02
VIN No.
Year Make
-
Model Style
Color
1FTPW14V59FA60925 2003
DODGE-DODG
RAM PK
RED
License Plate #
6232358
Stata Yeaz
Mast Damaged Area Approximate
Cost to Repair ar Replace
IL 20Y2
10 - FRONT DRIVER SIDE $500.00
County
Accident occurred within corporate limits of (city)
DUBUQUE-31
DUBUQUE.2100
Literal Description
ALGONA ST N AND LORAS BLVD
X-Coordinate
Y-Coordinate
00689681
04707828
If accident occurred outside of city
Direction
Newest City
limits show general vecinity:
of
Route (Cardinal)
Travel Direction
On Road, Street, or Highway:
At Intersection with:
Distance
Direction
Distance
Direction
Milepost Number
end
of
Or
Definable intersection, bridge, or railroad crossing
Officer
OFFICER SAMUEL WHITE
Badge No.
aw Enforc ant Case Number
Date of Accident Time of Accident
35
21-00281
04/26/2021 11:22 Hrs.
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Page 1 of 1
MIKE MURPHY FORD INC.
565 WEST JACKSON ST MORTON IL 61550
JANE THORNE
Home:
Mobile:
Work:
Email:
TYPE _..., DESCRIPTION
DOOR MIRROR - Remove & Replace - [DOES
Labor NOT include refinishing (where applicable).] F150
Power Mirror,Each
Jun 26, 2021 07:38 AM
YMMS:
2009 Ford Pickup F150
Engine:
5.41- Eng
License:
VIN:
Odometer:
PART # QTY PRICE LINE TOTAL
Parts DOOR MIRROR - [Contact Dealer with VIN for 9L3Z
proper application and price.l 17683-CB
Customer Signature:
- - $142.50..
1.0 $211.48 $211.48
Labor: $142.50i
Parts: $211.48
Shop Supplies:
$14.25
Hazardous Materials:
$1.00
Labor Taxes:
$0.00
Parts Taxes:
TOTAL:
$14.87
$384.10
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