Claim by Giese Sheet Metal Copyrighted
December 17, 2018
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Giese Sheet Metal Co., Inc. for property damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Refer to City
Attorney
ATTACHMENTS:
Description Type
Giese Sheet Metal Claim Supporting Documentation
���
� 1����"���
C�AIM AGAINST THE CITY OF DU�UQUE, IOWA
This written report constitutes yaur claim against the City c�f �}ubuque, 1owa. You should
complete this fc�rm in fu11 and attach any additional informatian that supports yaur claim.
The Glaim must be filed with #he City Clerk at City Hall, 50 W. 13�" St,, Dubuqtae, lA 52001. It �
will then be referred by the City Counci! to the appropria�te department fcar investigation.
Once that investigatic�n is completed, a report and recommendation will be submitted ta the
City Cauncil. Yau will be provic�ed wifih a copy of that report and reeommendation.
THE FINAL DECISI�N ON A�� C�AIMS IS MADE BY THE �ITY CUUNCIL. Nt� EMPLt�YEE OF �
THE CITY QF t7lJBUQUE HAS THE AUTHtJRITY TO MAKE ANY REPRESENTATIQN T{} Y{�U
AS TC}WHETHER YC}UR GLAIM WI�L. C3R WI�L N{�T BE PAID.
1. Name of Claimant: ��i-�� �� ��'�1l
2. Address: �,�`� ���- ,��i�e?' �
� '
City: �. �,'l� Sta#e: � �" Zip: "J���� '
�
���. �4����-�`�.� �
3. Telephane Number: „� '�
4. Qate of 1�cident: 1�� ` `c� �- � `��
5. Time c�f Inciden�: � �-l-�Y"�
6, Loca�ion c�f Incident {Be s�ecific): �� �� �....-�..�� �- �,��c� °�" �''���'�'r���'��.`� �
�-'�c��-�i
7. DESCRIBE ACCIDENT QR C���URRENCE THAT CAUSED INJURY OR DAMAGE. {Give
full details upon v+rhich you ba�e your claim, If a Gity employee was invc�lved, give the
employee'� r�ame.) �
��e� ��' `
��°�..YV� �':�Gs�..�...i�:...�� �Lf^. Y"1�^�C-'.X""1 S -'� ,+�,�..�c�('YZ.� r�`� 5 �. S"�'t�"'C.;��'v`l'� {��C�,.� a.��+'a I�
• _,T—
�
�—��� ` , `,� ,�
���'\c� t' '�"�'�...i #"l , ` ii`1 t� �,�t� ���'.�"1{3 f� V`�... �. �� '-�i_ �l�����„�Sc'�"'���
'--�=,� �r-�.s����•�.. u�'�-� �v 1 i �E- �'�.°�-i�a"�. i�.a�e��\ �, �-��..-�.. �aa.�v-v��� `�c..c:: �4'e_v.F�
�r.�..�.5r',
�. Wha#wer�weather conditions like? �,��,lc.����v°�t
�
9. Give name and address af any witnesses: ��.���,Y�� �,1c�°��x-��s��
10. Did police investigate? (If so, give names of r�fficers.)
���
'11. Was anyt�ne injured? {1f so, give names, address�s, and extent af injuries).
���
�
�
;
k
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.)
��.� ���.;�,
�
13. What other damages do you claim, if any? �� I'
�
�
�
�
14. Have you been compensated for any part or all of your claim by any insurance I
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. Why do you claim the City of Dubuque is responsible? j
�C�u�'�h� '4�`':�d�" ..`� �a .�/����tat.�,��.. �-�:i�°�.�- �°�� �"\
c ..�.
17. Have you made any claim against anyone else for damages as a result of this incident? f
�
(If yes, give 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?
;
i
Dated at Dubuque, lowa this � day of �i���`���r- , 20 I�
---�
,� (Signature)
� ,� ���� � (Print Name) � �
�� � �
� �� �' °"�
� � �
� %., t�
'� "�. � `�:
(Rev. 5/18) � � .�,~ �
� �
�
Copyrighted
December 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: Giese Sheet
Metal Co., I nc. for property damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referral Staff Memo
9
THE CITY QF r" �
�� �� MEMORANDUM �
Masterpiece on the Misszsszppi ;�
i
i
� � TRACEY STECKLEIN � j
PARALEGAL ;{
�
To: Mayor Roy D. Buol and 1
- Members of the City Council �
I
DATE: December 10, 2018 a
RE: I i �
�a rn Again�t#he City of Dubu��ae by Giese Sheet Metal Go. Inc. I
„
Claiman# Date of Claim Date of Loss Nature of Claim �
Giese Sheet Metal 12/07/18 10/08/18 Property Damage '�
Co. l nc. i
�
�
This is a claim in which claimant alleges that a sewer backed up onto claimant's property. {
I
I
This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa j
Communities Assurance PooL �
cc: Michael C: Van n/lilligen, City Manager
��
John Klostermann, Public Works.Director ;�
Stephanie Meyers, Giese Sheet Metal Co. Inc. �
!I
,�
;�
y
�
g
, �
9
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/EMA�� tsteckle@cityofdubuque.org
�