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Claim by Asbury Square LLC Copyrig hted March 1, 2021 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: 2G2, LLC. for breach of lease;Asbury Square LLC for property damage; Jackie Jones for property damage; additional claim information from Ronald Koehler for property damage;Aaron Rang for vehicle damage; Jacob Schlosser for property damage; additional claim information from State Farm a/s/o Michael or Jennifer Connolly for property damage. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Claim by 2G2, LLC Supporting Documentation Claim by Asbury Square LLC Supporting Documentation Claim by Jackie Jones Supporting Documentation Additional Claim Information by Ronald Koehler Supporting Documentation Claim by Aaron Rang Supporting Documentation Claim by Jacob Schlosser Supporting Documentation Additional Claim Information by State Farm a/s/o Supporting Documentation Michael or Jennifer Connolly Confidential ,� This communication and any attachments may contain information which is confidential j and privileged by law and is for the use of the designated recipient. If you are not the 'Y 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 (563)-589-4120 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. � I, 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 ;I 6) Credit Card Numbers � II� ;� If any dacumentation you desire to submit to the City of Dubuque contains any of the items above ;i this cover sheet must be attached directly to the confidential information and indicate the type of '� information that is included. ; ; ';I � i I, Jamie Smith , hereby certify that the � attached documents include the following protected information: � Social Security Number(s) Bank Accaunt Infarmation � ; Medical/Health Information Financial Information Personnel/Disciplinary Information Credit Card Number(s) I understand that this information may be distributed within the City organizatian or to agents of the City for processing and I hereby authorize the City to act accardingly taking all precautions to protect my information from unnecessary distribution. �„���",�'�.`"`W�-�� �.r ( '� - � C) � r Signat�� e Date CLAIM AGAINST THE CITY OF DUBUQUE, IOWA This written report constitutes your claim against the City of Dubuque, lowa. You should complete this form in full and attach any additional information that suppcarts your claim. j �� The Claim must be filed with the City Cterk at City Hall, 50 W. 13t" 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 vvill be provided with a copy of that report and recommendation. I� THE FINAL DECISION ON ALL GLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF ,� THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU i3 AS TO WHETHER Y�UR CLAIM WILL OR WILL NOT BE PAID. I !� 1 . Na�me of Claimant:Asbury Squ�re LLC �,� i 2 . Address:1694 Radford Road Suite 100 �,� i� City:Dubuque State: IA Zip: 52002 � � � 3 . Telephone Number:563-564-1480 � i � 4 . Date of Incident:2-12-2021 � '; 5 . Time of Incident:10:16 AM � 'i 6 . Location of Incident (Be specific):2255 JFK Road 7. DESCRIBE ACCIDENT OR OCGURRENCE THAT CAUSED INJURY OR DAMAGE. (Giv� � full details upon which you base your claim. If a City employe� was involved, give the � employee's name.) Received Call from Paul Davis City Water Department that line was broken and it had flooded our parking lot. We had to call a snow removal company to salt th� in± and nlow thp rpmaining sl�,sh a� a res�lt of th� wat�r lin� br�ak_ Pa�l indic�fi�d ta L� that City would pay for ice and snow removal caused by the line break. � 8. What were weather conditians like?Snow and Ice and Well below freezinq temperatures 9. Give name and address of any witnesses: Paul Davis Citv of Dubque Water Department 10. Did police investigate? {If so, give names of officers.) No � 11. Was anyone injured? (If so, give names, addres�es, and extent of injuries). None � 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 '� + damage.) No physical Damage but a large ice flow covered the parking lot we have pictures i available if necessary I� � �13. What other damages do you clairn, if any? None � 14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give narne and address of insurance company and amount paid.) No � '15. What amount do you claim from the City of Dubuque"? $925 16. Why do you claim the City of Dubuque is responsible? City water line break arad City Em��/ee resnonsible for fixing the line indicated to us that the cit�/ would �y for snow i and ice removal 17. Have you made any claim against anyone else for damages as a result of this ''� incident?(If yes, give name and address:) No I�� 18. If the answer to Question 17 is es have ou received an a ment from that source � Y � Y Y p Y , Ii and if so, in what amount? � Dated at Dubuque, I�awa this���ay of February , 20 21 - �7 �n,�...�.._._. � ;�%�`�''�`' (Signature) ,��`' ��� Jamie Smith `� `�` (Print Name) -z�=� � ;.,�; ''::� �' � � � ;�- `� �-�i � � � �:� �� �s � � (Rev. 5/18) r'.� � ������ � ����� � '�'�����+�r���f Y ���� � +�1�tn�"� _ I If gr�au i���+s���t��r��d��En�ury�ar���a��f�rwhi���++�����€��r�ih��it�+ar�r��c��it���ptt�y�����r�sporasi�l�,yc��a � rz��'y fdt��c��trr����inst E���i��. 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(��uv+�v�r, ii���r�f�ir�i�d�ra��c�k�y����ity���sr��i���d<�'���rl�h t�f�l��I�uvs�at, y�u���uJci b��€��r�t�i��st�t�;la�r r�aay lia��t th�#ir�1�<it�v�l�[�i����9�.���a�v��it. i ������� I NVOICE � Piersch 5now Removal LLC - ' 2181 Comanche Drive � Asbury, lowa 52002 United States 563-513-8438 , ��'�-�T°�� Invaice Number: 1122 Asbury Square Jamie Smith Invoice Da#e: February 16, 2021 i 2255 John F Kennedy Road Dubuque, lowa 520Q2 Payment Due: February 16, 2021 United States ' Amou�nk a+�e(1���): ����.QO _ � � - . SALT 5 $140.00 $70C1.00 PER TON OF SALT FOR ASBURY SQUARE FROM WATER MAIN BREAK. USED 1 SINGLE AXLE DUMP TRUCK LOADS TO SPREAD ACROSS. �' PARKING LOT. $140 PER TON PLOW TRUCK 3 $75.00 $225.00 TRUCK CHARGE TO COME BACK 3 TIMES AND II', SCRAPE UP ICE AND SLUSH FROM THE AREAS I WE SALTED TO MAKE THEM SAFE Ii . _ ... .. „ ... , .�,..,.,. .,��..,,. >. � I� Total: $925.OQ Amount Due (USD}: �925.0� i I Copyrig hted March 1, 2021 City of Dubuque Consent Items # 3. City Council Meeting ITEM TITLE: Disposition of Claims SUMMARY: CityAttorneyadvising thatthe following claims have been referred to Public Entity Risk Services of lowa, the agent forthe lowa Communities Assurance Pool:Asbury Square LLC for property damage;Ashlynn Johnson for property damage; Jackie Jones for property damage; Aaron Rang for vehicle damage; Jacob Schlosser for property damage; State Farm a/s/o Michael or Jennifer Connolly for property damage. SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description Type ICAP Referral Supporting Documentation THE CTTY OF DUB E MEMORANDUM MasterpTece on the Mississippi �ONI MEDINGER Legal Administrative Assistant To: Mayor Roy D. Buol and Members of the City Council DATE: February 23, 2021 RE: Claim Against the City of Dubuque by Asbury Square LLC. Claimant Date of Claim Date of Loss Nature of Claim Asbury Square LLC 02/17/2021 02/12/2021 Property Damage This is a claim in which claimant alleges claimants parking lot flooded due to water line break. 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 Blakeley Ihrig, Water Department Manager Asbury Square LLC OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)589-4113/Fax (563)583-1040/EMai� jmedinge@cityofdubuque.org