Claim by TFM Company Copyrighted
March 5, 2018
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Alex Helbing for vehicle damage, Kathleen Pfohl for vehicle
damage, TFM, Co./Tom Thompson for property damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City
Attorney
ATTACHMENTS:
Description Type
Claim by Alex Helbing Supporting Documentation
Claim by Kathleen Pfohl Supporting Documentation
Claim by TFM, Co. Supporting Documentation
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) Financiallnformation
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. Please indicate below the
type of information that is included.
I, , hereby certify that the attached documents
include the following protected information:
n/a Social Security Number(s) n/a Bank Account Information
n/a Medical/Health Information n/a Financial Information
n/a Personnel/Disciplinary Information n/a 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 City to act accordingly taking all precautions to
protect my information from unnecessary distribution.
Signature Date
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.
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Sig tu e Date
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CLACM AGAtN�T TME GITY OF C�UBUGlUE, It`1WA �'��
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This written repoi� constitutes yoc�r claim against the City af Dubuque, lowa. Yot� shou[d
complete this form in fulE and �tta�F� any additional information that suppor�s your claim:
The �laim must be filed with the:City Clerk at City HaCI, 50 W. 13��`St., Duk�uque, IA 520t?1. It
will then be referr�d by the City Cot�ncil to the apprapriate d�partment for investigation. '
Once fihaf invesfiigation is +comp[eted, a report and recommendatio� wiil be submitted to fhe
C1��/ C.O1117C1I. Y�u will be pr+avided wif� a copy �f that report and recamm�nc�atian.
THE FINAL DEC1S10N O�I ALL C�AtMS 1S MAQE BY THE CITY GQU�ICIL. NQ EMPL.C?YEE QF
THE CITY UF DUBUC;2tJE MAS THE AllTHQRITY TfJ MAKE ANY REPRESENTATION TfJ YCtU
AS TQ WHETHER Y�UR CLA1M W[LL aR WIL�. NOT BE P,AID.
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1, Name of C[aiman�. T�'M Go
2. A�fdress: 2 4a I�er er �1vc1
3. Telephone Numb�:r: 5fi3-5�6-8450
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4. C7ate of tnciclent; 8 Januar 2018
. ��. T�me Qf Ir�c�dent: �:30 AM �
6. Loc��ion of lnci�ent{R�sp�cific); _204D Ker�er-rt�,an�ole in parkina lot
�
7. DE�CRIBE ACGIDENT �}R C3GCURRENCE THAT CAIISEC� 1NJtJRY C)Ft DAlItIAGE. (Give
ful[ details upon which y�u ba�� ydur �[a:im. If a �ity emplcryee was involvedl, give �the
employee's r�ame.) �
City sewer backed up and clogged priva�e sewer fine. See Attached �>
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a �nr�,...a�..,..._ . sv_.. ,•�,----- ''r--^ ^- -- - --' . ;�+,. „ �
v. rr��a�: vY�fG YYCat11CF rL"Vf1U11lOIlS 11KE:! ��('aSOflal �, � ,��, w,,
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9. Give name and address of any witnesses: See Attached -.� ��.,� �` -�i".a,
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10, Did police inve�tigate? (If so, give narnes ofof#icers.) °�-
NO
1`�. Was anyone injured� (If so, give names, addresses, anct extent afinjuries).
NU
,
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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.)
Backed up sewage had to be pumped out and sewer line cleaned. See Attached.
13. What other damages do you claim, ifany?
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 amountpaid.)
NO
15. What amount do you claim from the City of Dubuque?
$750.00
16. Why do you claim the City of Dubuque is responsible?
City sewer pumping station failed to keep main sewer line open causing grease generated from other sources to
backup.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
NO
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, lowa this 22 day of February , 20 18 .
���:��� '�If-�-�r�s;,-�1 (Signature)
John F. Thompson (Print Name)
(Rev. 7/12)
Attachment to TFM Co Claim against the City of Dubuque
9. Give name and address of any witnesses:
Troy Kruser Tom Thompson
P.O. Box 223 11168 Holy Cross Rd
Dickeyville, WI 53808 Farley, IA 52046
Copyrighted
March 5, 2018
City of Dubuque Consent Items # 3.
ITEM TITLE: Disposition of Claims
SUMMARY: City Attorney advising that the following claims have been
referred to Public Entity Risk Services of lowa, the agent
for the lowa Communities Assurance Pool: Alex Helbing for
vehicle damage, Kathleen Pfohl for vehicle damage, and
TFM, Co. for property damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Staff Memo
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THE CITY OF
�U$ �� MEMQRAND � M '�
Masterpiece on the Mississippi �
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TRACEY STECKLEIN
PARALEGAL �
To: Mayor Roy D. Buol and �
Members of the City Council ';�
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DATE: February 22, 2018 ;
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RE: Claim Against the City of Dubuque by TFM Co. �
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Claimant Date of Claim Date of Loss Nature of Claim 1
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TFM Co. 02/22/18 01/08/18 Property Damage 'I�
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This is a claim in which claimant alleges that a city sewer backed up and clogged
claimant's private sewer line at 2040 Kerper Boulevard. i
This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa 'Ii
Communities Assurance Pool. '�
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cc: Michael C. Van Milligen, City Manager �
John Klostermann, Public Works Director 'I
John F. Thompson, TFM Co.
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OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 j
TE�EPHONE (563)583-4113/Fax (563)583-1040/Ennai� tsteckle@cityofdubuque.org �
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