Claim by National Casualty Company/#1 Green Cab_Hahlen Enterprises Copyright 2014
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: National Casualty Company/#1 Green Cab for vehicle
damage
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City
Attorney
ATTACHMENTS:
Description Type
Claim by National Casualty Company Supporting Documentation
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: National
Casualty Company/#1 Green Cab for vehicle damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referral Supporting Documentation
THE CITY OF
UUBUQUE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: March 22, 2016
RE: Claim Against the City of Dubuque by National Casualty Company,
subrogating for Hahlen Enterprises LLC, d/b/a #1 Green Cab
Claimant Date of Claim Date of Loss Nature of Claim
National Casualty 03/21/16 02/14/16 Vehicle Damage
Company
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This is a claim in which claimant alleges that a City of Dubuque Public Works employee
collided with a parked vehicle near the intersection of West 11th and Walnut Streets.
The City employee swerved to avoid colliding with the vehicle of claimant's insured who
ran the stop sign at that intersection.
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
Diana Hansen, National Casualty Company
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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CLAIM AGAINST THE CITY OF DUBUQUE, IOWAuCC)
This written report constitutes your claim against the City of Dubuque, Iowa. You sho I ��
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.
1. Name of Claimant:
2. Address:
3. Telephone Number:
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4. Date of Incident:
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5. Time of Incident: '. tom=
6. Location of Incident (Be specific -!'TRT
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 j
employee's name.)
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8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
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135 LLP, �
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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 a
damage.)
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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.)
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 name and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source, G
and if so, in what amount?
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Dated at.D e,Iowa this � f day of �#� 20/(
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(Rev. 7112)
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P.O.Box 4110
Scottsdale,AZ 85261-4110
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Nationwide'
is an your side
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March 17, 2016 I
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City Clerk's Office j
City Hall
50 W 13th Street
Dubuque, IA 52001
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RE: Our Insured: #1 Green Cab Hahlen Enterprises LLC DBA
Our Claim No.: 01694425
Date of Loss: 2/14/2016
Your Driver: Joseph Breson
Your Vehicle: 2013 CHEV
Dear City Clerk:
National Casualty Company carries a policy of insurance on the above-referenced insured. A claim has
been presented under that policy for payment of property damages and/or injuries arising from this loss.
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Our investigation reveals that your driver is legally liable for a portion of the damages sustained in this
loss. We are therefore looking for contribution from the City of Dubuque for the damages to the innocent
party vehicle in the amount of$1050.31 which National has paid to the claimant. I
Enclosed please find our supporting documentation for this claim. We will look forward to hearing from
you to discuss this claim. I can be reached at 1-800-423-7675, Ext. 2646.
When this claim has been resolved, please issue payment to National Casualty Company as subrogee
for#1 Green Cab Hahlen Enterprises LLC DBA and mail to P.O. Box 4110, Scottsdale, AZ 85261-4110.
S'n`cereIy,
Diana Hansen
Recovery Representative
Extension 2646
Enclosures: Supporting Document & Police Report
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Underwritten by National Casualty Company
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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 (663)-6894120 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
Ci of this Claim Against the City
Signature Date