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Claim by Bard Materials Copyrighted February 19, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Bard Materials for property damage, Kendall Coulson for vehicle damage, and Jeff Kintzle for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Claim by Bard Materials Supporting Documentation Claim by Kendall Coulson Supporting Documentation Claim by Jeff Kintzle Supporting Documentation M��1 _� � �1 c>S�-es�'c�v.�..�n � '� 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 supports your claim. � � The Claim must be filed with the City Clerk 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 will be provided with a copy of that report and recommendation. � I 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. j i 1. Name of Claimant: �� r V Y�a4-�rca.l.� 2. Address: g�l �eriacr C�" ��.��-y�e....- S�l � 3. Telephone Number: v��. ��-fp�9 � l , I 4. Date of Incident: L?81�a.�/�7 ; 5. Time of Incident: ��-'�p � � 6. Location of Incident (Be specific): _____�/� Shop c�v��i�,.5 c�.'+' a�oc.r�, �oea��i�n ; 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give �i full details upon which you base your claim. If a City employee was involved, give the employee's name.) _ _ _ . J2 Q. 4�.�`��-C.t�.G+ ��Cc,c,��•e,w�C '; , ;j � ; r o. vvnai�ivere weainer cvnaiiion5 iike% . 9. Give name and address of any witnesses: )'�la'�1-' (,V�`nsc�e��c.-,. I�(� ��s -��I��eS �� ';w�. Wa((e�.c y,or� -- Wecle,�6Qrq �P((��- G�� 10. Did police investigate? (If so, give names of officers.) c� P � g � I� � 11. Was anyone injured? (If so, give narnes, addresses, and extent of inJuries). � � a �� i 1 , � i 9 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.) AAAI/� /'� �(/�/,�1 /� ��/� � /� p IY �Y ��5� CVS� �✓l V'I�V�'��M1 l �'.`W � 13. What other damages do you claim, if any? �o�- j , � � � � 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.) �o i � , � 15. What amount do you claim from the City of Dubuque?�ag,7� �71p � ,;, - � � , � 16. Why do you claim the City of Dubuque is responsible? � /�oc i w S�e w-P�^ (i�e �iac./c. wp � � 17. Have you made any claim against anyone else for damages as a result of this incident? 'i (If yes, give name and address.) A�� i 18. If the answer to Question 17 is yes, have you received any payment from that source, ' and if so, in what amount? 11, � � � I� Dated at Dubuque, lowa this � day of ��n.w.a�ry , 20�. ; � � / , / � 9/G i. D„�� / /�/ . n �_ 0. It+:....,...a....�v �� iyna�u�C� � �.S�� (Print Name) � �r'� � � � �.� '-�?'�"'" � f.-. �.�,� �. ��,. (Rev. 7/12) i �.� ��„� �� ;. F .j.:.3 � e+'" ,^� _.�^"` � � �¢ fT#a � . � � �s�«.d' � ��> � i i 1 1 � p ' � � �'� �I � Date: 8.2.17 � q � Location: 801 Kerper Ct, Dubuque IA i i t BARD Materials " i �i To: City Of Dubuque Ii l On August 2"d 2017 BARD Materials called Willenborg Plumbing and Heating pertaining to the drains in �'�� the shop not draining. Jimmy Willenborg came to 801 Kerper court and was going to jet the drains in �� the shop thinking that would solve the problem. Jimmy was not able to make headway with his '�� pressure jet. When we pulled the cover off our grease trap there was sewage in the grease trap. Jimmy II; mentioned that we should not have sewage in the trap, unless the main backed up.Jimmy continued to - ji pressure jet the lines working towards the city main. Jimmy had spent 3 days jetting through what was I�' plugging the lines. in order for the lines to be fully cleaned out the we needed to have the rease tra cleaned out. We had g p I� to call in Welu Pumping to clean the trap out on 8.4.17 and 8.17.7. �� Due to the evidence that the lines were plugged from the main line backing up, our plumber suggested to pass on the cost to city for reimbursement. Total cost to jet and clean out the drain lines was: I, Willenborg Plumbing and Heating—Jet drain lines-$2451.76 i� Welu Pumping Service—pump out oil/grease trap- 428.00 li ��OTAL�. .�$2y879:7� �; �II �i �i ��i li i; 'i� il F 1 's � � � � � � '� I�� n � , B � � �I � � �, � � � i CENTRAL REGION �� T 563 583 6494 C 563 590 h456 i eo, 4CERPERCT STEVE KLUESNER � �UBUOUE, IA 52002 CENTRAL REGION SALES� OPERATIONS MANAGER 1 I . sreveKc�B6lRDMATERIALS.conn . � � i --------._--- .. .__ ._. _------ �i N II � {� >I � I I � ij � I I I I II� � � � � � � � � � ''�k�.r.�. � � . � � r' 9b15�'kY� T'�."'s��. 3^�� : � ��"��.fi�y�',�Y��gz�,�$� `�',1"�`l #*��e�'�„'�''`^��'�' � �,'��g r�`+ � � �� . � S�t�� {��.�� .� `a�" a�,�e�^:�'�,.�`A��-. � � � 4 � � � 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: � ;; i 1) Social Security Number(s) j 2) Medical/Health Information �, 3) Personnel/Disciplinary Information �I 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, �i this cover sheet must be attached directly to the confidential information. Please indicate below the type of information that is included. �, , hereby certify that the attached documents '�� include the following protected information: I,,� 'I Social Security Number(s) Bank Account Information � Medical/Health Information Financial Information � Personnel/Disciplinary Information Credit Card Number(s) I� , ; � 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 City to act accordingly taking all precautions to � protect my information from unnecessary distribution. ; � � Signature �ate � � I have read the information above and do not have any confidential documentation to submit to the � City of Dubuque as part of this Claim Against the City. � o?� /gc�`(g ; 1--0 ; S nature Date � � 9 d , � Copyrighted February 19, 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: Bard Materials for property damage, Kendal Lee Coulson for vehicle damage, and Jeff Kintzle for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation � THE CITY OF DUB E MEMORANDUM Masterpiece on tlze Mississ2ppi � TRACEY STECKLEIN � PARALEGAL To: Mayor Roy D. Buol and Members of the City Council � DATE: February 4; 2018 RE: Claim Against the City of Dubuque by Bard Materials Ciaimant Date of Clairn Dafe of Loss Natu�e of Clairr� ; Bard Materials 01/31/18 08/02/17 Property Damage � � This is a claim in which claimant alleges that a City sewer rr�ain was plugged causing � sewage to back up into claimant's property at 801 Kerper Court. i , 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 Y John Klostermann, Public Works Director � Steve Kluesner, Bard Materials ,� � � OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA � SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 � TE�EPHONE (563)583-4113/F,vc (563)583-1040/EMai� tsteckle@cityofdubuque.org � � �