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Claim by Jose Lopez RamirezTHE CITY OF DUB E MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL „-kv To: Mayor Roy D. Buol and Members of the City Council DATE: August 22, 2014 RE: Claim Against the City of Dubuque by Jose Lopez Ramirez Claimant Date of Claim Date of Loss Nature of Claim Jose Lopez Ramirez 08/21/14 08/14/14 Vehicle Damage This is a claim in which claimant alleges that his one year old son locked himself in claimant's car while claimant was unloading groceries. Police were dispatched and responded and forced entry in order to gain entrance to the car. 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 Mark Dalsing, Chief of Police Jose Lopez Ramirez 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 Lay, 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: J C'Se 2r._' Te` liCtkrANCZ 2. Address: 3+it(tcreS4 Act oy4 3 %bNoe to SZODZ 3. Telephone Number (5C,3 S r 8 f3 111) ((03 ' 510.11 8350 4. Date of Incident: ° G/ i i -V / y 5. Time of Incident: 2. ®ZO P yr (A-pw ) 6. Location of Incident (Be specific): Wct14rnar PrKtn3 1-0+ 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.) o�� I ,� • a m ke s en 4 -i -he car and m Son Wa ere, 5o _ nal ed 4 -he ponce •for help. Hy Son was srft,n3 Nn -I-he Car wh°la .. uoa.s unloading my 9roceries and he locoed +he oay doors. 8. What were weather conditions like? �t Was Very hot 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) ycs. Officer Abbv IReckman. `L1_ aro (0% 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). Ho . 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.) The Officer br©Ked -Fhe W,nci ,ter? girder 40 open &he rigs, 13. What other damages do you claim, if any? 1\10 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? Three hctnc r and th1'rf5i Seven c/o/&. 16. Why do you claim the City of Dubuque is responsible? E3ecav5e +he Officer -told me 4ha-1 the O/ Lentil help me cof4h -the Cas -F. 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) 140 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 2j day of AUgucl' , 20 14 i (Signa ure r ,iosc Lei et \.Gdw,:c-c 2 (Print Name) 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 City of Dubuque contains any of the items above this cover sheet must be attached directly to the confidential information and indicate the type of information that is included. hereby certify that the attached documents include the following protected information: Social Security Number(s) Bank Account Information Medical/Health Information Financial Information Personnel/Disciplinary 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. Signature Date I have read the information above and do not have any confidential documentation to submit to the City of Dubuque as part of this Claim Against the City Signature Date