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Claim by Robert Wilbricht 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 ��L6 �V l ., , � �G�Yi'� � CLAIM AGAINST �['HE CITY (�F I)�TBU�UE, IOWA � �'� . This written report ronstitutes your claim a�ainst the City of Dubuque, lowa. You � should complete this form in full and attach �r�y additir�nal 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 repork 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 makp any representation to you as to � whether your claim will or will not be paid. ,� � ii 1. Name of Claimant: '��,e�,�� A).�� '' ��,�;�t��e,� (',a�� ,��°� j ,� /�� t�►Ix,� �-��=��0 �1��, -��` � �� 2. Address: , �-.�-�- „ ;; �� 3. Telephone Numbsr � �-- �'�.. � �� .� '' ',j 4. Date of Incident: �� /�� , i 5. Time of Incident: d��r,° � � '� ' ��"r� ��,��~-, �! _ 1�.�.- ��°�i ' � /7��—r�c. 7�� -� ��e�a ,�. �j �a 6. Location of Incide� (Be specific): �� °o, �� :�.�-- , � , , 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 emplo ee's nam�e1 � � ,.�g /�. �' J� �4; ,� ' � �� t�� C�. �' � � � � a �P �� -.s�' �;, � (,�D ^> �'f��*-�'�, � �-- � ��,u� �l�� pC�P'"�G�� `� � �,, 8. What were weather conditions like. �J `��/ � ,f � �� .�'�--��r�� ,� � ��'�:��'� (° ��..- �,";,¢� �, 9. Give nam and address of any witnesses: o -c��'��. �- � � �l � �° r�r � r� �%�.�- f, ��'� %' i 10. Did police investigate? (If so, give names of officers.) J,�`� k T ' 1�. Vilas anyone injured? {If sc�, give rtarnes, addresses, and exteni of injuries), �� `� 12. W�s any damage dc�ne fia property? (If s�, describe property and the extent �f d�mages. Attacn esfiimates of damages or d��cribe basis for ascertainir�g extent of amage ) ,� � 1 �-- --� '� r� :�-- 1� • '� � !� � �� 13. What c�ther d a es do you claim, if an ? � � ° �� a� _ � �� H �.,:�� ; 1 . Have you been com�erfsa�ed for any p�rk or all af yo�ar claim by any �� ins�aranc�cornpany? (If so, give name and address of insurance cc�mparty and � amc�t�nt paid.} � r � a 15. V11hat amou t do yo cl�im fr�m the City of Dubuq�e� t��' � �� I �� , a - � � � '16. Why do yc�u claim the Cit �f �}ubuq�ae is responsible? � ,; � � �� ' � � � r � � a ��'`� ,r�� 1 �� ..� 7��- �� "��''- � 17. Have you made any claim against any�ne else far damages as a result of � this incid�r�t? �If y�s, give name and addre�s,) �8. If the �nswer ta Question �7 is yes, have yau received any payment from that source, and if sc�, in what amount? .....,..�..-�. �,� / Dated #his ��day of � � , , 20 {�. t.� �'" ��:p� � W �a � � {�ignature) `i�,- �A� �.�. - �� a��'� , �� l ,�' �,.��`�°��-,�� ; �� - ,� � � {Print Name} �'� �-,� � � e� �� ;� ,� � i { 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 tl THS CTTY(7F � ��.TB E MEMORANDUM � Masterpiece Qn tFte Mississippi � TRAC@Y STECKLEIN � 4 PARALEGAL ',� I � �� To: Mayor Roy D. Buol and I' Members of the City Council DATE: May 1, 2018 RE: Claim Against the City of Dubuque by Robert Wilbricht �� Claimant Date of Claim Date of Loss Nature of Claim �J ;i, Robert Wilbricht 04/30/18 12/11/17 Property Damage I; This is a claim in which claimant alleges that a watermain break caused water damage to II' the storage room and yard at his residence. j 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 1 Denise Ihrig, Water Department Manager ; Robert Wilbricht � � � a � � � �� OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org � �