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Claim by Mark Matel
Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL M F;MORAN DUM To: Mayor Roy D. Buol and Members of the City Council DATE: February 3, 2014 RE: Claim Against the City of Dubuque by Mark Matel Claimant Date of Claim Date of Loss Nature of Claim Mark Matel 02/03/14 01/26/14 Vehicle Damage This is a claim in which claimant alleges that a City of Dubuque snow plow truck struck claimant's parked vehicle. 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, Street & Sewer Maintenance Supervisor Mark Matel OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001 -6944 TELEPHONE (563) 583 -4113 / FAx (563) 583 -1040 / EMAIL tsteckle @cityofdubuque.org 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. A4ark Mg-re' 1. Name of Claimant: 2. Address: ao59 6c/der, EgOt Dr. ) Dibt,gcie_ Sas &3 3. Telephone Number: (6-63) 663 r 4. Date of Incident: 1 / a6 < 1 5. Time of Incident: ° (6 ,4M 6. Location of Incident (Be specific): Li grd ee_e ckce. tN 5- t5t rexT �b �e�;fi 9e 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.) (s+y of DIAbuque 5nb a X16 bu s;cSe - scuqed clurio 61,` /e5. St,bi,V plow bpee-ecto by Rah q(( L.u44bw z . rt 8. What were weather conditions like? S> >ow 4CCUrvtu I ex:kJ &Me{ P r ■ br 1k 9. Give name and address of any witnesses: RACY C1tz, �erbme, }tt&fsch 10. Did police investigate? (If so, give names of officers.) Yes, C had C t Zc r 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). Na 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.) 1 5) e4t re 1 611 tedcu, °y An Pc r 461a9 c ci s 1Je 111‘.1-6. v 13. What other damages do you claim, if any? /ity p©t tg (d1e Lpwe.rcl (Mf 3 P14y.ef) P nad 1-v s edrir a je . 1ms,s Sin ;et: in Tile_ 5 tre T 415 1-66 k_ (To s 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.) Nv 15. What amount do you claim from the City of Dubuque? V/ $ // 5 73,30 (t4, je5er 4 f es'[.' ).,,cAThs 1)&4 5 ' f/e i y`,'Grrc; �rP YtSEs� 16. Why do you claim the City of Dubuque is responsible? S A co l o w d r, v e,. 61/ C1 7 Erne l o Y ee ea u; ed deat1 r., cy e W 6)-f -F e r , (. he 0 Ct5 citi�3 't1 T clrYNler I4 :Ili ein a ffe ti5 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 e f,A4t y , 20 (Signature) Mar l 6 14 e( (Print Name) (Rev. 7/12) &64 Po ce %epc't Q cell; 5 c,r, repoiy est'muteS 5tateme-.i13 of Odd, av1Cc( ref P ti ot6