Claim by Brett Kilburg / DBA Dubuque Dental AssociatesCity of Dubuque
ITEM TITLE:
SUMMARY:
SUGGESTED DISPOSITION:
ATTACHMENTS:
Description
Furlong Claim
Kilburg/Dubuque Dental Claim
Lindecker Claim
Loewenberg Claim
Swain Claim
Vans Evers Claim
Copyrighted
November 6, 2017
Consent Items # 2.
Notice of Claims and Suits
Renee Furlong for property damage, Brett Kilburg d/b/a
Dubuque Dental for property damage, Deanne Lindecker
for vehicle damage, Chris Loewenberg for vehicle damage,
Martina Swain for vehicle damage, Frank Vans Evers for
vehicle damage.
Suggested Disposition: Receive and File; Refer to City
Attorney
Type
Supporting Documentation
Supporting Documentation
Supporting Documentation
Supporting Documentation
Supporting Documentation
Supporting Documentation
N V M
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. You should
complete this form in full and attach any additional information that supports your claim.
The Claim must be filed with the City Clerk at City Hall, 50 W. 13th 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 will be provided with a copy of,Lhat report 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 MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
. Name of Claimant:
2. Address:
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3. Telephone Number: c13L, G L42. 4
4. Date of Incident: 8 30 i
5. Time of Incident: I) NILt4L4CN1
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6. Location of Incident (Be specific): lei To cloi+A f- 14-i7f4f.laki Q,0
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7. DESCRIBE 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.)
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8. What were weather conditions like? btAinl
9. Give name and address of any witnesses: T 0.,141)iAr•Th(L.
10. Did police investigate? (If so, give names of officers.) trrii -Mc
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.)
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13. What other damages do you claim, if any? 14aria
14. Have you been compensated for any part or all of your claim by any insurance
company? (If so, give name and address of insurance company and amount paid.)
15. What amount do you claim from the City of Dubuque?
16. by d you claim the City of Dubuque is responsible?
responsible?
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17. t v'eco ade'a y claim against anyone else for damages as a result of this incident?
(If yes, ive name and address.)
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this 24 day of 0 e
. 2011.
(Signature)
--OvAtix ebr r i -4-e . or (Print Name)
OW Saler—RV-1 -.
ckAticuE VEATAi, ASS o c Vt e S 'c
(Rev. 7/12)
cD
Confidential
This communication and any attachments may contain information which is confidential
and privileged by law and is for the use of the designated recipient. If you are not the
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.
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
6) Credit Card Numbers
If any documentation you desire to submit to the City of Dubuque contains any of the items above
this cover sheet must be attached directly to the confidential information and indicate the type of
information that is included.
I , TX44
include the fo
DE G -e NI a
owing protected information:
, hereby certify that the attached documents
Social Security Number(s) Bank Account Information
Medical/Health Information Financial Information
Personnel/Disciplinary Information Credit Card Number(s)
I understand that this information may be distributed within the City organization or to agents of the
City for processing and I hereby authorize the Citgo act accordingly taking all precautions to
protect my information from unnecessary distribution.
Signature Date
/have read the information above and do not have any confidential documentation to submit to the
C. of Dubuque as p- • • this laim Against the City
Signa
Date
BHA
DUBUQUE DENT"L ASSOCIATES, PC
City Clerk @ City Hall
City of Dubuque
GOWest l3mStreet
Dubuque, IA 52001
To Whom It May Concern,
0uAugust JO,ZOl7lwas nodfiodbyDardnRomb of the City of Dubuque's Water Departrnent, that repair
work was going to commence on the northernmost lane of 'John F. Kennedy Road, sometime after 5 PM that
afternoon. Water to our building, Dubuque Dental Associates, was going to be shut off, as it had been shut off
on prior occasions (to perform repairs to water lines), specifically August, 9, August 10, August 30th and as
recently as October 23.
The stafof Dubuque DentaAssociates discovered on the morning of August 31st that the toilets in all five of
the bathrooms "gurgled" and would not refill properly.
Willenborg Plumbing was dispatched on September 1sito snake the plumbing, as the issue was thought to be
a result of a localized problem within the clinic. Willenborg was unable to determine the cause of the
problem, nor were they able to correct the problem. In turn, Kruser Septic Service was asked to inspect the
sewer lines with a camera. Upon said inspection, Kruser Septic found that the sewer line leading into
Dubuque Dental Associates had been compromised after the August 30th work that the City of Dubuque
completed. Fortunately, Kruser Septic was ahle to repair the daniaged pipeline.
Brett Kilburg, d.b.a. Dubuque Dental Associates, is asking to have the plumbing bills from both Willenborg
Plumbing and Kruser Septic Service reimbursed: this was an upset caused by an error from someone in the
City of Dubuque's Water Department.
WiUcuborgPlumbing, Invoice 4372 $383.66
Krusei Scptic Service, Invoice 31328 $375.00
If necessary, contact Brant Schueller, as he is in possession of the jump drive which contains photos providing
proof of the compromised sewer pipe which leads to Dubuque Dental from Kennedy Road. Brant's
recommended to Dr. Kilburg to inform the city of these (attached) bills.
Thank you for considering this petition for reirnbursenient,
Sincerely,
Tanya TjarmDogcobardt,MBA
Clinic Manager
Dr. Brett Kilburg
Dr. Melanie Stuntz
1890 John F Kennedy Rd
Dubuque, IA 52002
(ph) 563.556.4234
(fx) 563.556.0597
www.dubuquedentalassociates.com
City of Dubuque
ITEM TITLE:
SUMMARY:
SUGGESTED DISPOSITION:
ATTACHMENTS:
Description
ICAP Referrals
Copyrighted
November 6, 2017
Consent Items # 3.
Disposition of Claims
City Attorney advising that the following claims have been
referred to Public Entity Risk Services of Iowa, the agent
for the Iowa Communities Assurance Pool: Renee Furlong
for property damage, Brett Kilburg d/b/a Dubuque Dental
for property damage, Deanne Lindecker for vehicle
damage, Chris Loewenberg for vehicle damage, Martina
Swain for vehicle damage.
Suggested Disposition: Receive and File; Concur
Type
Supporting Documentation
Masterpiece on the Mississi„,ppi
TRACEY STECKLEIN
PARALEGAL
MEMORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: October 26, 2017
RE: Claim Against the City of Dubuque by Brett Kilburg d/b/a Dubuque Dental
Claimant Date of Claim Date of Loss Nature of Claim
Brett Kilburg 10/26/17 08/30/17 Property Damage
d/b/a Dubuque Dental
This is a claim in which claimant alleges that while the City of Dubuque Water Department
was performing repair work near 1890 JFK Road, claimant's underground water line was
damaged.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Denise Ihrig, Water Department Manager
Brett Kilburg
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL tsteckle@cityofdubuque.org