Claim by Connor AmbrosyCopyrighted
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
,rn v fy)
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA .5-f eCrN 16
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 Y014R CLAIM WILL OR WILL NOT BE PAID.
, A
1. Name of Claimant: , Connor W. Ambrosy
2. Address: 10351 Whitetop Road
City: Dubuque State: Iowa Zip: 52003
3. Telephone Number. 563-542-6260
4. Date of Incident; Tuesday, June 1, 2021,
5. Timeof Incident: approximately 5:30 p.m.
6. Location of Incident (Be specific): I was at the residence at 1705 N. Grandview and my car
was parked in area in front of approximately 1738 N, Grandview facing north on east side of street.
7. DESCRIBE AWDENT OR OCCURRENCE THAT CAQSED� 11WORY OR DAMAO . (Gi"
fWI details �upon which yoo base your� c141m. � if � a 04 employee wao involved, give the
employeels� name.)
My car was parked legally on the street, and a bus came by and caught the drivers mirror of
my car and ripped it off. It ripped my drivers mirror off and put scratches on side of my car.
8. What were weather conditions like? Clear and sunny, -about 70's
Brad Northouse, 1738 N. Grandview Avenue
9. Give name and address of any witnesses: Span Soler, JZ05 N.. _Grandvig-w-8yenue
10. Did police investigate? (if so, give names of officers.) (video from Ring Doorbell)
No, I did not call the police - I called the Jule directly left message that the bus hit my car. They called back right away
— and advised th t thj�y woyld give it to manaqement in the morninq and h@Xq,,someone call me back. I sRoke with
Russ Steckle nd he advised that they could look at the tapes and he sent me claim forms.
11. Was anyone injured? (if so, give names, addresses, and extent of injuries).
No 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.)
Yes, the mirror was riped off the driver's side of my car.
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.)
No, the car was parked legally, so it was not my fault.
1 S. What amount do you claim from the City of Dubuque?
Cost of getting a ne mirror installed.
16. Why do you claim the City of Dubuque is responsible'?
It was a Jule bus owned by the City of Dubugue.
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 3rd- dav of June . 21)21 .
Connor W. Ambrosy (Print Name)
0.
(Rev. 5118) 7f
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: 6/10/2021
RE: Claim Against the City of Dubuque by Connor Ambrosy
Claimant Date of Claim Date of Incident Nature of Claim
Connor Ambrosy 6/3/2021 6/1/2021 Vehicle Damage
This is a claim in which claimant alleges claimant's vehicle was damaged due to 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
John Klostermann, Public Works Director
Connor Ambrosy
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