Claim by Roger Schadler_BernardiMasterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
M IH,MORAN DUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: May 19, 2014
RE: Claim Against the City of Dubuque by Roger Schadler, filed by Partners
Mutual Insurance
Claimant Date of Claim Date of Loss Nature of Claim
Roger Schadler 05/19/14 01/14/14 Personal Injury
This is a claim in which claimant alleges that he fell and was injured while walking on
the sidewalk at 898 Spires Drive.
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
Psihoyos, City Engineer
Tom Kopp, Engineering Technician
Linda Albert, Claims Representative, Partners Mutual Insurance
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
IS1 PARTNERS
MUTUAL INSURANCE
An affiliate ofPenn National Insurance
May 15, 2014
CITY OF DUBUQUE
CITY CLERK
50W 13TH ST
DUBUQUE IA 52001
RE: Our Claim No: FD35496LA
Our Insured: Joseph Bernardi
Date of Loss: 1/14/14
Dear Sirs :
Enclosed is the completed Claim Form you requested we complete regarding the above loss. At
this time we are still in the process of investigating this loss. We will contact you once our investigation
is complete.
LLA
Enclosure
Sincerely,
1°-".:
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Mrs. Linda Albert
Claims Representative
Partners Mutual Insurance Company
20935 Swenson Drive • Waukesha,Wisconsin 53186-2057 phone: 262.798.5050 • fax: 262.798.5040
www partnersmutual. com
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 West 13th St.,
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. 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: 12q-
2.
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2. Address:
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3. Telephone Number
4. Date of Incident: 1j14-1)4
5. Time of Incident: 00 A.144.
6. Location of IncidentBe specific): (i1' (�.� 5�1��; 1�tf�'u��� IK
7. Describe the 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.)
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8. What were weather conditions like?
9. Give name and address of any witnesses:
40. DiOolice investigate? (If so, give names of officers.)
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3/28/2014 8:32:27 AM
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.)
13. What other damages do you claim, if any?
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.)
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15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
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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 this day of %ati l
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, 20
(Signature)
. A /bail` I
(Print Name)
3/28/2014 8:32:27 AM
Masterpiece on the Mississippi
Partners Mutual Insurance
20935 Swenson Dr.
Waukesha, WI. 53186-2057
Dubuque
NI -America City
I 1 1 I
2007 • 2012 • 2013
RE: Filing a claim against the City of Dubuque
City Clerk's Office
City Hall
50 W. 13th Street
Dubuque, IA 52001-4864
(563) 589-4120 office
(563) 589-0890 fax
ctyclerk@cityofdubuque.org
www.cityofdubuque.org
March 24, 2014
Mrs. Albert:
If you wish to file a claim against the City of Dubuque regarding insured Joseph
Bernardi, we would request that you complete the enclosed claim form and return it to
the City Clerk's office at the following address:
Mr. Kevin Firnstahl, City Clerk
City Hall — City Clerk's Office
50 West 13th Street
Dubuque, IA. 52001
Once the claim has been stamped in as received by the City Clerk, it will be forwarded
to the City Attorney's Office for investigation.
Please feel free to contact me if you have any questions regarding this matter.
Thank you,
Trish L. Gleason
Assistant City Clerk
50 West 13th St.
Dubuque, IA. 52001
Phone: 563-589-4120
Email: tgleason(c�cityofdubuque.orq
Enclosure
cc: Tracey Stecklein, City Attorney's Office
PARTNERS
MUTUAL INSURANCE
An affiliate of Penn National Insurance
March 20, 2014
CITY OF DUBUQUE
CITY CLERK
50 W 13T" ST
DUBUQUE IA 52001
-.ter _O._..-1.... --Joseph 'Bernardi
Our Claim; FD35496LA
Date of Loss; 1/14/14
Dear Sirs;
RECEIVED
14MAR 2.4 AMIO:33
City Clerk's Office
Dubuque, IA
We are placing you on notice of an injury sustained from falling on the
sidewalk located at 847 Spires Dubuque, la on the above date. At this time we are
currently investigating the incident. Please acknowledge receipt of this letter.
LLA
Certified RRR
Sincerely,
Mrs. Linda Albert
Claim Representative
Partners Mutual Insurance Company
20935 Swenson Drive ■ Waukesha,Wisconsin 53186-2057 ■ phone: 262.798.5050 • fax: 262.798.5040
www.partnersmutual.com