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Claim by John Herrig Copyrighted January 6, 2020 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUM MARY: Sara Burke for property damage; John Herrig for property damage; Carol Klinkhammer for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Claim by Sara Burke Supporting Documentation Claim by John Herrig Supporting Documentation Claim by Carol Klinkhammer Supporting Documentation � �� � . � �,� a � x ��� �r����� � CLAIM A�Al1�ST 1'HE GITY t,�F DUBUQUE, IOUVA � � ,; ; � T�is written r�port cr�nst�tutes your c�aim agains� the City o� L3ubuque, lowa. You s�ould ti compl�t��his forr» Mn fu�I and a�tach any additic�nat infarmation tl�at suppor�s your claim. i� The +Glaim must be filed w��h the C��y +Cter�t at City Nat�, 50 W. '13t�' 5�., Du�it�que, 1A 52D01< 1t ; wi�[ then be ref�rred b�r the City Co�uncil t� th� �pprt��riate departme�tt '�or it�vest�g�tit�r�. �� �nce that inves�tigatian is campl�ted, a repa�fi �nd recomrn�nda#ic�n wa11 b� submi�ted to th� �°; �it�t Cc�unci�. Yau wi11 be pr�vided with a� copy crf that repart and recc�mmenctatic�n. '� �; THE �1NAL C3�CISIt}1�I UN ALL..CLAINIS IS NMAbE E�3Y THE CiTY CC1Ut�IGIi.. NC7 �MPLt3Y�E C}� i; �"HE CITY {}�' DUBUt�UE �AS THE AUTHQR�TY T{J �NiA�CE ANY REP�ESE�ITAT1t�N T{� Y4U ';; AS TC7 WNETNER YC�UR ��.AlM W�LL �?R 1tV1�L �1 �E PAED. `�; h " '1. Name of C]�imant: ��r� ��. ,� ;; _ 2, Address: � �� ����'',�"''�-- ,� ; _--------- �j G�ty. ����- �- S#ate:�--�r��e� Zrp• ���., ;� �. Telephvne N mber: �� - ,� ' 4. Date Qf Inc�der�t. �� �'� ���`�. � r $ 5. Tim� of Incident: r�"��- .e3��''�, �r'� 6. L,oca#i�r� +�f(��i�l��t Be ��e��� : � � ..,�=.��� � ��J�, �...�.-'�� �.,,� � � ) - �� �- G��"���-- �2s�?.�/"/� � ,��:�.�...��' �. �'� �'�'"�"f � � —� ;; G�� �� c���``` � , 1 �� �� �; . � 7. ESGRI�E AC�I�ENT !�t t3CCURRI��ICE THAT �AUSE� INJU�tY t�R DAMACE. �C�ive full details upar� vrrhi+ch �ou bas� yraur �clai�� 1# a Ci�ty employee was inv�lved, g�ve the emp��ye�;s rt�ame.� i� >� ` '" ! �'�''`ed."`� �t� fc'� �^ ��C'r`'�1`d2 �' y s d��-��� ��s'� /��^'./'�- k / y '"'� � ����i�--�w�=^'� ��-5� G!�'* � t'��_ . �„/C.i��� �.� '� ��� �� t�.�'J�t� t � d � � 8. �hat w�r� weather c�n�i�ti�ns lik�? � � �'�. �"'�'��' l�� �-- ���''�'1.� �`�� � � f� � � 9. Give name �nd address of any witnes�es: � �`� e s �,„� � 1{�. Di o1ic� investi a e? If s�, ive r��mes vf off� �:rs. ����� t ; p � � 3 } p ��-� ��. �--��-���� �'��- `�������-� �- �� � � !' �- �:�� ` � § 11. Wa anyane injured? {�f sv, c�ive nam�s, address�s, ar�s� ��ent af injuries).����"' t� . � � � �� . � �!, ;� � � �2, Was �r�y darr�age done to property? {If so, d�scribe properfiy and the extent of �'� d�tll�ge�. Att�►ch �s�imates of damages or de�cribe basis fvr as�e�-taininc� extent crof '',� y damage,} 4 ��� �� �� " « ;: , � � � �� � � '�3. 1N}t�t +��her dama�es do you claim, if��y? `����'�°' � h � �} E3 �i �� �� ��? �7`'"�.r�''. �`��� ,, �, '14. Have yau been compertsate�i fc�r �ny p�rt c�r �il o# your claim by ar�y insurance cc�mpa y? {If so, give narne and address of inst�rat�ce �c��p�ny and arrtount �aid.} '� , Lr° , 3 1�. hat atr�r�unt� yau claim fr�am th� City of Dubuque? ; i 16, Why d+a out�la�� e Ci y f dubuq is e p : sible? . • " � ���`,�' ��.:�1 � ��''��.- �� �.e�.����� �.�' ', �►t�c�'.�"''" - t� _ 17. Have you,�n de any cla' ac���r�st�ny�n� e�se f�r��r��g�s as a resu##o#this inciden#� ,"; (1f yes,�ive name a�nd address,� _ %f � � '18. If the answer t� Questio� 't7 s yes, hav� you cece�ved ar��r payr�a�rat #rc�r� ���t sc�;�rc�, L� ar�d if sa, in what am+�unt? '� 3 q � �� � u C�ated a# Dubuqu�+�,�lowa t�is ,��` clay t�f � � , 2D�`�. � ti , � � � � � �°" �Signat�re} � � ���. ��. � �Prir�t Narn�� ;v_� � � .. � ��;: #,� �„s �. � � k—�._.; :� �., r }„+_, a � -� �. �=� i,"'e ; :� � m;� �� i {Rev. 5!'t$� n ::> -�;; -� �~-; r=; �, �n. . tL? �.„ , � , � � � CQnfid�r�#ia1 � This communi�ation and any atta�hments may con#ain informa�Ean whicn is �onfidenti�( � and privi�eged by �aw an�t is f�r ti�e use of tt�e �designafied recip�er�t. If you are ne�t the � in#encl�d recipi�nt, you are hereby no�tified that y�u f�ave r+eceiv�d f�is commt�t�ica�ion irt r err��r, ar�d that any review, di�ciosure, dis�emination, distribu#ion or cc�pying of i�s ��n�ents � is prohibited. Plea�e na#ify City t�f Dul�uqcte imm�diately by telephone a# {�63�-58�-�120 �f �� your receipt �f thes� iterns and d�strc�y th� cc�mmunication and any attachments � y irnmediately. Fu�ther disc�osure of #t�is in�`ormation may violat� state and federal ` restrictic�ns�. � Confident�al infc�rmafiion may inclu�e th� foflowing: �; �) �vc�al Sec�rity Number�s} 2) M�dicaClNealth �nformation �, 3� PersonnellDisciplinary �nfc�rmatic�n �, 4} B�nk Acc�unt Informatfon ' 5� �inartci�l �rtformatit�n I'�. 6} Credi# C�rd �Vumbers If�ny dc�curr��rifiation you des3re ta submit t� ttte City of �?ub��gue cvntains �ny vf#he �fiems a�ove this cc�ver sheet must be at#ached directly to th� �on�den#ia1 informa#ion �nd indicate the type �� ;� information #h�t is ir�cEuded. ; , �i � �I; �, , hereby Gertify tttat the atfiacn�d dacumen�s ��'� include�he fallc�win� prot�cted informati�n: I _`v..._.::Social Securit� Numb�r(s} B�nk Accaunt Infarma�ion (, �; MedicallF��alt1� Information �'inancial I�ft�rmat�or� � Per�on�e]1Disciplinary lnform�#ic�n ��tedi���r� Nt�mber{s� �� k; 1 undecstand that this informatir�n may he distribu�e�d within the City �rganizat�on or to agents of fihe � City for prc�cessing and 1 �ere�y au�hari�e t�e Gity ta act accordingly t�king �11 r�r��a�t�or�s #� s protect my in�ormatic�n frc�m ur�n�cessary �lis#ribution. � � �� � � � � ` � � �' I i �t�ar� Date Copyrighted January 6, 2020 City of Dubuque Consent Items # 3. ITEM TITLE: Disposition of Claims SUMMARY: CityAttorney advising that the following claims have been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool: Sara Burke for property damage, John Herrig for property damage, and Carol Klinkhammer for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo Dubuque THE CITY OF AII�A�eriea City � �../ � � w�ra�w�avicu�.aa.m: , ' 'o r II Masterpiece on the Mississippi zoi�*zoi9 TRACEY STECKLEIN PARALEGAL � MEMO � n i� To: Mayor Roy D. Buol and Members of the City Council ,l DATE: December 30, 2019 i RE: Claim Against the City of Dubuque by John Herrig � Claimant Dat� of Claim Date of Loss Nature of Claim �i '�1 John Herrig 12/30/19 October/November 2019 Property Damage I'� '�,i This is a claim in which claimant alleges that excessive rainfall caused flooding in j claimant's basement at 429 Kaufmann Avenue. il � I This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa i Communities Assurance Pool. � cc: Michael C. Van Milligen, City Manager I�� Jon Dienst, Civil Engineer II '� Q�rQ�? �l��!ehri�g, ri��i! Engi!�eer !! I John Klostermann, Public Works Director � John Herrig � � � � � 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