Claim by Charles Jacobs Copyright 2014
City of Dubuque Consent Items # 3.
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: Charles Jacobs
for vehicle damage
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Supporting Documentation
THE CITY QF
DT_T E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: January 25, 2016
RE: Claim Against the City of Dubuque by Charles Jacobs
Claimant Date of Claim Date of Loss Nature of Claim u
Charles Jacobs 01/22/16 09/17/15 Vehicle Damage
This is a claim in which claimant alleges that a large branch fell from a City tree and
damaged claimant's vehicle which was parked on Whelan Street.
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
Steve Fehsal, park Division Manager
Steve Pregler, City Forrester
Charles Jacobs
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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
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Copyright 2014
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Charles Jacobs for vehicle damage
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City
Attorney
ATTACHMENTS:
Description Type
Claim by Charles Jacobs Supporting Documentation
HVM
CLAIM AGAINST THE CITY OF DUBUQUE, IOWAPUJ "115
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, 1
You will be provided with a copy of that report and recommendation. y
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; ayyl ' Tarob-5
2. Address: Rk d(t 1
3. Telephone Number -v. " ,SK- / 1
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4. Date of Incident: /-7
5. Time of Incident: '° — --,)."YT T PAI
6, Location of Incident (Be s ecific):
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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.) If i
8. What were weather conditions like?
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9. Give name a d addresany with sses:1�11r, / /I
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10. Did police inves igate? (If so, give names of officers.)
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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 dam e.)
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13. What other damages do you claim, if any?
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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.) j
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15. What amount do you claim from the City of Dubuque?
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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 namend address.)
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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 GAP(! ' 20
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CAN A \VV/L-- C
CD
(SignaYure) 0
H , M I
(Print Name)
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on or about September 17,2015 the Dubuque area experienced a rain and wind storm.My automobile,
a 2004 Chevrolet Impala,was parked on Whelan Street adjacent to my home at 216 Bradley St. in
Dubuque.The car was parked underneath a tree which grows between the sidewalk and the curbing on
the street.
About 2:30 PM that day I was leaving my home for a dentist appointment when I saw a large branch
from the tree under Which my car was parked had fallen and hit my car.The branch was about 15 feet
long and about 6 inches in diameter.When I looked at the car I did not see any damage.So I pulled the
branch off my car. It was then that I noticed that the spoiler on the trunk of the car had been broken.
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I went to the dentist appointment and upon my return called the Street Department.A person there
referred me to Leisure Services. I spoke to a gentleman there who told me that he had already received
reports about the tree and had been by two view it, but did not see my car. I explained to him that I had jl
pulled the branch off my car and left for a dentist appointment,and I was concerned about the tree
lying in the street. He told me he was the only one with a chainsaw and was concerned with larger
problems.The next morning the tree was cut and removed by the Street Department. j
Subsequently, I took the car to ABRA Auto Body and Glass to be repaired.They purchased a spoiler from
the Focal salvage yard,painted it to match my car,and installed it on my automobile.The total cost was
$335.98.A copy of their bill is attached.
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There were also a couple of dents on the car near the rear window post. Because the car is dark blue, it
is very difficult to photograph these dents.And given the age of the car,a reasonable person would not
repair this.A copy of the bill is attached,as is my receipt for payment.
I have also enclosed two short videos of the tree and the branch just as they were when I pulled the
branch off the car. I did not place the branch back on the car to show it as i found it. However my
neighbor, Carol Birch,saw the branch on the car. If you need any other information please contact me
directly at 563—588—3111.
Charles Jacobs
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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
Person nel/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
it of Dub part of is Claim Against the City
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Jah, OZ &2
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Signat&e Date