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Claim by Cathy Ludwig Copyrighted May 7, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Nicole Homer for personal injury, Cathy Ludwig for property damage, Dennis Schlegel for property damage, Robert Wilbricht for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Homer Claim Supporting Documentation Ludwig Claim Supporting Documentation Schlegel Claim Supporting Documentation WilbrichtClaim Supporting Documentation �� LAI� AGAI�T�T �'H� CIT�Y f�F 1��BIT+QI�E, IOWA �.� � � , Thi�written repc�rt +constitutes yc�ur claim �gainst the City of Dubuque, lowa. You ��.`�-��i`` should cc�rnplete this form ir� full and atta�h �ny additiona3 informatio� that supporks your claim. � � The cfaim must be fifed with t�e City Clerlc at Cif�r Nall, 50 W�st 13th St., � Dubuque, IA �2001. It will t�en be referr�� fio the a�propriate department fc�r invesfii�ation and ta the City Attorney's Office, On�e that investig�tior� is � cc�mpletet�, a repc�r� and recommendation will be s�abmitfied fio #he Ci�y Council. � Yc�u wil[ be pravided wifih a copy of that reporfi ar�d recammenda�ion. `� �The fina� decision an all cl�irns is mad� by the City Cc�uncil. No employee of the � City �f C}ubuque Yras the autharity to mak� any r�pr�s�r�tation ta yc�u as to rrvhether yc�ur claim will or will r��t be paid. � i 'I. Name of Claimant: " � ' ��. ��`� 2. Addres�: ��°��.� r�''��'f � � � �� 1` ��1�". � � ; �. Telephone Number �� . � � �.� Y��.'�,.�c�� 4. Da�e af Incident: ��'�� °��'1� � �" � � i� - �,�' d � ` ��.,�z '� `�"��v�'��r � � � �. Time ofi lncident: ��`��i,��;..�..� n ��_ .� � � 6. L�cation c�fi Incident {Be specific): r �".� �--� �`�� l��,.�t�" �r°�� r�`�. �� 7. Describe the acci�er�t or occurrence that caused inj�ry or damage. {Give fuil det�ils �apor� uvhich y�� b�se yo�r claim. If a Gi�y employee was invc�lved, giue � the employee's n�me.) , � � � � -�- ;P � � � - � �` .� -r� � ` _ . � t�f _ A>r� � _ _ , � �'�,r.� ` �"'�:�' d�� ' � . �- ` �r �~ ,�..,� ��, €��... I t�F�..�' �° -�`�� f� ��.� ��°.r�� 'a�r'�, _ 8. What were w�ather con�it�on like? f �f r,��-��` �=�� 9. Give name and address af any witn�sses: �� .�� .��a�� ,� � �.. �" �',� .� � � ,�.�.��.�'� `�� ; '1{}. Did police invesfiigafie? (lf s�, give names of af�icers.} I, �� ; � � . � 11. Was any�fr�e injured? {Ef sc�, give names, ac�dress�s, and extenfi af injuries�. � 1� � 12. Was any damage d�ne to property? �1f so, describe property ar�d the ext�nt of damages. A�tach �stimates c�f damages or de�cri�i� basis fc�r ascertainin� � extent af damage. � c � ? �� c� ' < 1 ' �� _� E�� , � ��r" �� _..� �_ � o� �� r� .�'.�.� � � 13. What a�l�er damages do yc�u claim, i�any? � , � ..� �`� � � .��°.��1� i ',�� -��" ��—�°�..� � � �� .'�`d b � �; 14. Have you been compensated for �r�y part or�all of yaur cfaim by any '; insurance ct�mpany? (If so, c�ive name �t�d address of insurance com�arry and ;, am�unt paid�) �; �� ,� � :� ; 1�. 1Nha� amount do you claim fr�m the City of ��b�que? � � F a� � 1�;� °� l �a� .�.��J..S"" � � � ` `�, F �6. Why do you clairn the City c�f Dubuque is res�or��ible? � � � � � �:`-a �f.��: G�d�� -� �"�� C. �a � ��'" - `�1 � - ..� ; �1/� � � .7 � � t�f � ` � �� / _ �✓ � 17. Nave yau made any claim against anyone e�se fcar damages as a result of � this inci�n�t`� (If yes, give name and address.) �8. 1fi the answer ta Q�estion 17 is yes, have you rec�ived any payment from fih�t source, and if so, in what �rnaunfi? C` �+.�.�..5. Dat@fi fih IS '� {�c�}r of !��--,��,� , 20 � �� ? � �° � tn-�� ` '� � ; � � �� 1�11��IC�� " } `�' ! "�� s f a }" �.,:� �� ' °�°" �'4../f�.�` ��g _..' -.�- _--- ..�� -=�' �7 3 § �Print �lame) � � �� c � �9 Confidential This communication and any attachments may contain information which is confidenfiial 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 imm�diately by telephone at (563)-589-4120 of your receipt of these items and destroy the communication and any attachments ;� immediately. Further disclo�ure of this information may violate state and federal '� � � restrictions. � � . � Confidential information may include the following: � � 1) Social Security Number(s) 2) MedicaVHealth Information �', 3) Personnel/Disciplinary Information � 4) Bank Account Information !l 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 and indicate the type of ij information that is included. � ,I ,i I, ��C,�1 ��s !�''!� , hereby certify that the attached documents �','i include the following protected infica�mation: � � � � � h, �, Social Security Number(s) Bank Account Information � II Medical/Health Information Financial Information '� II Personnel/Disciplinary Information Credit Card Number(s) � h 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. � 1 � �� Signature Date � � i I have read the information above and do not have any confidential documentation to submit to the I City of Dubuque as part of this Claim Against the City j /�, � ,, t.- � ,�"., �. � �.��..� Signature Date Copyrighted May 7, 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: Cathy Ludwig for property damage, Dennis Schlegel for property damage, Robert Wilbricht. It is further advised that the claim from Nicole Homer for personal injury be referred to Cottingham & Butler Insurance Services, Inc. the agent for the Dubuque Regional Airport. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo THE CITY QF � � i� D'LTB E MEMORANDUM � Masterpiece an tlie Mississippi TRACEY STECKLEIIV ' PARALEGAL �, To: Mayor Roy D. Buol and ; Members of the City Council I !i DATE: April 19, 2018 �� RE: Claim Against the City of Dubuque by Cathy A. Ludwig � �. Claimant Date of Claim Date of Loss Nature of Claim I� ; Cathy A. Ludwig 04/16/18 2016-2018 Property Damage �; This is a claim in which claimant alleges that the sidewalk at 1573 Marjorie Circle buckled ; and cracked due to possible surface or watermain leak at the adjacent property. ' ! i This daim has been referred to Public Entity Risk Services of lowa, the agent for the lowa ___ _ Communities Assurance Pool. � � i � cc: Michael C. Van Milligen, City Manager Gus Psihoyos, City Engineer � John Klostermann, Public Works Director i Denise Ihrig, Water Department Manager Cathy A. Ludwig � � , � OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA � SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 � TE�EPHotvE (563)583-4113/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org , !