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Claim by Dennis Schlegel Copyrighted May 7, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Nicole Homer for personal injury, Cathy Ludwig for property damage, Dennis Schlegel for property damage, Robert Wilbricht for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Homer Claim Supporting Documentation Ludwig Claim Supporting Documentation Schlegel Claim Supporting Documentation WilbrichtClaim Supporting Documentation �� i i i , ��c��,�.:1 ' �� .� ' CLAIM AGAINST �'HE CITY �F I��TBUQUE, IOWA � , This written report �onstitutes your claim against the City of Dubuque, lowa. You should complete this form in full and attach any additiQnal information that supports your claim. The claim must be filed with the City Clerk at City Hall, 50 W�st 13t" St., ' Dubuque, IA 52001. It will then be referred to the a�propriate 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. i ; The final decision on all claims is made by the City Council. No employee of the City of Dubuque has the authority to mak� any representation to you as to whether your claim will or will not be paid. 1. Name of Claimant: �. �,1/ � �, ,,��, �j ��- ;� 2. Address: ,� � � ,..��a �� , � 3. Telephone Number �L� � r ..�,�� -�..� � �/ -'',�6.�� ,� '��a"� � �� i 4. Date of Incident: ___�" � � � �'� �� A .�--- �/� �° ��'� �' � C�'�✓�� .�a� - i ', 5. Time of lncident: �7 � a0 � „��'"a - �G� .�'' i`'�s��c',�'' ; � � 6. Location of Incident (Be specific): 'i ��/ .�'a ��` �a",.�ay"� ,�,s� � � I � � 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.)�°'`�'7'r�.�� i �i��z�.� �i � ,�•��/c� r��2/C�� ,s� �/-�/,�',�-�� .�a�`�� ' � I �,�v'� �'��.�d.� —' cc,�� r� 17 c�� k' �e�✓� .��`F,� , ��"/-� �'',�'��o /� ��79�`v� C�,.�t�.� �t� ��' �.�/�°�� /::'�I�/� 'f �i'�� I � � � 8. What were weather conditions like? .,.`�u'.�Jr�?/;�' '" 1�.�"c�:.�►� �,n�+ �ra'a�'J�/'`�� 9. Give name and addr ss of any w��"tnesses � �`./��.' �s�'/�;',d-� C.�eI�,�.�,� r � F 10. Did police investigate? (If so, give names of officers.) � F d � � � I �� , � , . � 1�. Was anyc�ne injured� �if so, give names, addresses, and extent of injuries}. � � s � a � 1�. Was any d�mage done ta properfiy? (If sa, describe prop�rty and the exte�rt � of damages. Attac� estimates of damages ar de�eribe basis f�r ascertaining extent af d�mage.} � . � � t�� c'".�.�� " ,��a� �-��, � ..�"� �" � v�.�� / ...5'�l /�3 i� �Pr'�� a, ��s Gt �3�Or�. /�i � �.�a � � � � ii 13. Wha� ofiher dam�ges do y�u claim, if any? ;' � � �4. Nave you been compensated far any par� or al1 �f yo�ar claim by any !� ir�surar�ce company? (If sa, give narne arrd address �f ir�surance cc�mpany and '; arnount paid.) �� a ,; i', 15. Whafi am��nt dc�you �laim firc�m the City af Dubuque? � .1�;��..�:�"` �' z� r�'�,��i� �u l� C�S� � I� 16. Why �o y�u claim the City of Dubuque is resp�nsible? � ,��°� �`i� �' � � � �.a�"�� ` 1..� �t��'�,� �✓,��,� � ; ��,�t�x � r'� � � � � 17. Have yo�t rnade any cl�im agairtst anyone else for damages as a result of #his incide t? (If y�s, giv� name ant� address.} ,.� ,_ � � �8. if the answer to Quesfiian 17 is yes, have you recei�ed any payment frc�m that � saurce, and if so, in vtirhat �mount? � � � �� C� y ...�'.�� .��. ��` � � � � � Dated this da c�fi � , 20 ��r �� µ�� ,.�.�'�'� ✓°�,� � � `"' �y: ° } (Signatur�} � � �� a.�.��;� +�4 f�'�� !�� ? �i r (Print Name� � � � � 3 � � Gc�nfiCler�fii�I This cornmunication and ar�y a##achments may cor��ain information which is con�denfia� � and privileged by law and is for #he us� of th� designafied reci�ien�. If you are not th� � int�r�ded reci�ient, you are i��reby r�otified t�at y�u have received �his commt�nicatior� in error, ar�d th�t any review, dis�lo�ure, dissemir�atian, di�tributic�n or copyinc� of its cantents � �s proh�b�ted. Piea�e r�otify C��y c�f Dub�aque �mmedaat+�ly by telephan� at (563)-5�9-4'120 of your re+c�i�t of these item� and d+�s�roy the cc�mmu�icatian and �ny att�c�rnent� immediat�ly. Furfiher discl�sure of fhis informatic�n m�y violate s�ate �r�d federal r�strictions. � � Confidenti�l infarmation may ir�cl�de the following: � � ,� � � � � � � 1) Socia( ��curity Number�s) ; 2) MedicallHealti� Informa�ion � 3} PersonnellC}�scipl�nary Infc�rma�ion � 4} Bank Aecc�unt lnformation : 5) Financiallnformatic�n � 6) Gredifi Card Numbers � � � If any dacumentatiflr� you desir� to su�mit tc� the City of D�buque contains any of the items aboue � this cover sheet m�st be a�tached directly fio the cc�nfidential inf�rmation and indicate �h� ty�e of � �nforrnation that is included. �; !I 1 , hereb certif that the afi��ched documents � , , Y Y � ir�clude#he fallowing protected in�ormation: ' � � Social Security N�rnber{s) Bank Accaunfi Infc�rmation � s MedicallHealth Information Financial lnfarmatian � � PersonnellDisciplinary Ic�formation Credit Card Number(s) � � 1 understand �hat this infc�rmati�n may be distributed within the City organization c�r to agents of fihe Ci#y far processing and I hereby aufihorize the City to aet accardir�gly fiaking all precautions to prc�#ect my infarmafiion firom unnec�ssary distribution. � �ignature Date � � � b k 1 haue read the informatian above a�d do n�t have any confidential d�cumentation tc� submit #a the � Ci�y o Dubuque as par� c�f this Clai Against the Ci#y � . �� i Signature Dat� 3 � � � � � Copyrighted May 7, 2018 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 lowa, the agent for the lowa Communities Assurance Pool: Cathy Ludwig for property damage, Dennis Schlegel for property damage, Robert Wilbricht. It is further advised that the claim from Nicole Homer for personal injury be referred to Cottingham & Butler Insurance Services, Inc. the agent for the Dubuque Regional Airport. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo TFiE CITY OF �'LB � MEMORANDUM ' Mc�sterpiece on the Mississippi i TRACEY STECKLEIN � PARALEGAL n ti I��, To: Mayor Roy D. Buol and � Members of the City Council DATE: April 20, 2018 � � ,� . , i: RE: Claim Against the City of Dubuque by Dennis M. Schlegel I; "i Claimant Date of Claim Date of Loss Nature of Claim �� C i' Dennis M. Schlegel 04/20/18 04/20/18 Property Damage !i � This is a claim in which claimant alleges that the driveway at 221 Southgate Drive is i sinking due to a watermain break and repair. � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager � Denise Ihrig, Water Department Manager Dennis M. Schlegel f � I�' � i � � � � � � � Y F, OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA � 0 SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 ; TE�EPHONE (563)583-4113/F,vc (563)583-1040/EMai� tsteckle@cityofdubuque.org ;, . � � N