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Claim by Gerald Klein Copyrighted September 17, 2018 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Kelly Casperson for vehicle damage, Jerald Kinsella for property damage, Gerald Klein for property damage, Abby McGrane-Ralston for vehicle damage, David Prince for vehicle damage, Steve Ruden for property damage, Daniel Scott for property damage, Sisters of the Presentation for property damage, Brock Tyner for vehicle damage, Morgan Weaver for vehicle damage, Doug Winner for vehicle damage, Suit by Michael and Jacqueline Wood for vehicle damage/personal injury. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City Attorney ATTACHMENTS: Description Type Casperson Claim Supporting Documentation Kinsella Claim Supporting Documentation Klein Claim Supporting Documentation McGrane-Ralston Claim Supporting Documentation Prince Claim Supporting Documentation Ruden Claim Supporting Documentation ScottClaim Supporting Documentation Sisters of the Presentation Claim Supporting Documentation Tyner Claim Supporting Documentation Weaver Claim Supporting Documentation Winner Claim Supporting Documentation Wood Lawsuit Supporting Documentation �� , _��-- . � CLo4lM AGAINS�' THE CITY OF DUBUQUE, IOWA CYt��21�J Vt � �� -� This writ#en report constitutes your claim against#he City of Dubuque, lowa. You should complete this form in full and attach any additional information that supports your claim. I� 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. a Once that investigation is completed, a report and recommendation w.ill be submitted to the '' City Council. You will be provided with a copy of that 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. i � � 1. Name of Claimant: -_�,��r �(�Y�.�1�,,a ii 2. Address ` . � �f City: State: ..� Zip: ' —�-- � ' i , i, � 3. Telephone Number: ��y��` ;� ! � �, 4. Date of Incident: - r; � � G� 5. Time of Incident: � , � 6. Location of Incident (Be specific): � � , � �, _ rj 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.) � � � � �h � 1 ' .s'? 8. What were weather conditions like? 9. Give name and address of an witnesses: Y 10. Did police investigate? (If so, give names of officers.) "�� 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � , � . � '12. Wa� any �amage done to �raperEy? {If s�, d��cr�be property and the extent of damages, Attac� estimates c�f damages or describ� ba�is for ascer�aining ext�nt of damage.} � � wl � � � � � �1 , '[3. What oth�r darn�ges do yc�u claim, if anY? � � � � 4 14. Have yau b�en c�mpensa#ed for anY pa� or all of your claim by any insurance ` �, �c�m�aar�y? {If�a, giv� t�ar�e �nd �ddr�� of ins�arar�� rrrp,�r��r �r�d �rn��n� paid.} li � 15. Vl��t annc►unt � yo claim fr m th� C'ty €�f Dubuqu�? ,� ' ! � � �� 16, W1�y do yau clair� �he City c� Dubuque is responsible? � p ; ;; 17. Nave you r�tade any claim �g�inst anyane else fo�-d�mages as � r�s�lt of�his in�ident? ��; {[f yes, gdve name �nd addr�s�.� � � 18. If th� ansv��r to Questian �17 is yes, h��ve ycau received �ny paymer�t from that sc�c�rce, � and if so� in wh�fi amour�t? ; � � � , Dated at Dub�q�e, lowa this _�� day af � � - , ,��„� , 20_��•. ,� i � �� {Signa�ure) � � ,.m� c � �• , � _ .��,�te�l.�. �� (Prir�t Name) �� ;� �=.�; �' �-�, -�� "; �� ;w� � r'� �;a c" �:.�`: � - �-"� i--�-`; - . �"•;,7.. .:...p'„ � C�.<».E � 9� �R@V. rJl'�� " � � � a F ; � 3 ` � j # � a t' Confid�n�ial � Ti�is communic�tion and any attachments may con�ain informatic�n which is confidential � ar�c! privi�eged by law and is far the use of the desit�nated recipient. If yt�u are not th� � intended recipient, you are hereby notified that you have r�eceived this communication in '� error, and that any review, di�clasure, dissemina#ian, distributior� or copy�ng of its con#ents !a is prohibit�d, Please r�otify City ofi Dubuque immediately by �elephone at (563}-58�-4't2� of I. your receipt of #hese items and destroy the cammunicatifln and any a�tachmenfis immediately, Fur�her discfosure of this informatiort may violate state and federat ; r�stric�ions. . '' � � E, Confic�ential inf�rmation may ir�cl�de the fallowing: 7 , ;i 1} St�cia! Security Number(s} � 2) Med�cal/Fleal�h Informa��c�n � 3} Personr�el/Discipllnary lnformation 4) Ban�C Account lnformafii�n '; 5} Financial Informatian '; 6� �redifi Card Numbers � If any dacum�n�atio� yo� desire to submit to the City c�f Dubuque eantains any c�f the ifiems abc�ve � this cover s�eet must be attached directly to the confidential ir�formati�n and indica�e the type t�f '; ir�farmation that is ir�cluded. 1 � ; � a � � � 1, , hereby certify thafi the afitached documents � include the following �rotect�d infiorma�ion: � �, Social Securifiy Rfumber(s} Bank Account Inforrnafiion � �� Medical/Health It�fc�rmation Financial Information � r 7 PersonnellDisciplinary Infc�rrnation Credit Card Numk�er{s) � �; I underst�nd that this information may be distributed within the City organiz�tian or to agenfis of the � City far prc�cessing and I her�by authorize the City fio ac# ac�ordingly taking all prec�u#ions to � profiect my information from unnecessary distrzbutit�r�, � � � � � ��€��i a � Gt � �I{��1��U r� Q�� 1y, ! � � � Copyrighted September 17, 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: William Baum for vehicle damage, Jerald Kinsella for property damage, Gerald Klein for property damage, Lynn McCormick/Partners Mutual Insurance for vehicle damage, Abby McGrane-Ralston for vehicle damage, David Prince for vehicle damage, Steve Ruden for property damage, Daniel Scott for personal injury/property damage, Sisters of the Presentation for property damage, Morgan Weaver for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo � 'i'Hfi CITY OF ��,„,. � I�LT� � � E MEMORANDUM � Masterpiece on the Mississippi � � TRACEY STECKLEIN 1 � PARALEGAL � � To: Mayor Roy D. Buol and Members of the City Council II DATEe September 5, 2018 � H RE: Claim Against the City of Dubuque by Gerald Klein ',� I; Claimant Date of Claim Date�ofi Loss Na#ure of Claim ��,�� i „ Gerald Klein 09/04/18 08/25/18 Property Damage i i� This is a claim in which claimant alleges that sewage water backed up into the basement '�i at 2769 Central Avenue. I! a 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 � John Klostermann, Public Works Director , Gerald Klein � � � � � � , OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA Su�rE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHorvE (563)583-4113/Fa,x (563)583-1040/EMai� tsteckle@cityofdubuque.org . �