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
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CLAIM A�Al1�ST 1'HE GITY t,�F DUBUQUE, IOUVA � � ,;
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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.
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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. '�
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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.
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'1. Name of C]�imant: ��r� ��. ,� ;;
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2, Address: � �� ����'',�"''�-- ,� ;
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G�ty. ����- �- S#ate:�--�r��e� Zrp• ���.,
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�. Telephvne N mber: �� - ,� '
4. Date Qf Inc�der�t. �� �'� ���`�.
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5. Tim� of Incident: r�"��- .e3��''�, �r'�
6. L,oca#i�r� +�f(��i�l��t Be ��e��� : � � ..,�=.��� � ��J�, �...�.-'�� �.,,� �
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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�
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�'�''`ed."`� �t� fc'� �^ ��C'r`'�1`d2 �' y s d��-��� ��s'� /��^'./'�- k
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8. �hat w�r� weather c�n�i�ti�ns lik�? � � �'�. �"'�'��' l�� �-- ���''�'1.� �`�� �
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9. Give name �nd address of any witnes�es: � �`� e
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1{�. Di o1ic� investi a e? If s�, ive r��mes vf off� �:rs. ����� t ;
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p ��-� ��. �--��-���� �'��- `�������-� �- �� � � !'
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11. Wa anyane injured? {�f sv, c�ive nam�s, address�s, ar�s� ��ent af injuries).����"'
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�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 '',�
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damage,} 4
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'�3. 1N}t�t +��her dama�es do you claim, if��y? `����'�°' �
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'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.} '�
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1�. hat atr�r�unt� yau claim fr�am th� City of Dubuque? ;
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16, Why d+a out�la�� e Ci y f dubuq is e p : sible? . • "
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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
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'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? '�
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C�ated a# Dubuqu�+�,�lowa t�is ,��` clay t�f � � , 2D�`�. �
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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 �
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irnmediately. Fu�ther disc�osure of #t�is in�`ormation may violat� state and federal `
restrictic�ns�.
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Confident�al infc�rmafiion may inclu�e th� foflowing:
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�) �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. ;
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�, , 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 (,
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MedicallF��alt1� Information �'inancial I�ft�rmat�or�
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Per�on�e]1Disciplinary lnform�#ic�n ��tedi���r� Nt�mber{s� ��
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1 undecstand that this informatir�n may he distribu�e�d within the City �rganizat�on or to agents of fihe
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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. � �
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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
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Masterpiece on the Mississippi zoi�*zoi9
TRACEY STECKLEIN
PARALEGAL �
MEMO �
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To: Mayor Roy D. Buol and
Members of the City Council
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DATE: December 30, 2019
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RE: Claim Against the City of Dubuque by John Herrig
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Claimant Dat� of Claim Date of Loss Nature of Claim �i
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John Herrig 12/30/19 October/November 2019 Property Damage I'�
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This is a claim in which claimant alleges that excessive rainfall caused flooding in j
claimant's basement at 429 Kaufmann Avenue. il
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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 �
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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