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Claim by Joseph Burbach Copyrighted March 18, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Joseph Burbach for property damage, Matt McFadden for Mak's Bait Shack for property damage, Roeder's Outdoor Power/James Roeder for vehicle damage, Robert Sigwarth for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Burbach Claim Supporting Documentation McFadden/Mak's Bait Shack Claim Supporting Documentation Roeder's Claim Supporting Documentation Sigwarth Claim Supporting Documentation rr��1 J `�v� CLAIM AGAINST THE CITY OF DUBUQUE, IOWA � • 1-�� 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 Cit Hall, 50 W. 13t" St. Dubu ue IA 52001. It � Y � q � a 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 u City C�u��l. Yeu w�li be �r��vid�d rnrifh � copy ofi that report and recommendation. a � THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEf OF 'a THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU a AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. j :� �i. Name of Claimant: �S'�i�,� ,��i( ✓��,°�� . �, 2� Aciciress: ��1' �� n�' C.@1Gc� � /'� _ � C. ,-- , i City: l./(�P 1�C�Gi' �'E � State: � �L'�-- C� C�'� �- Zip: -.�t�� ` � � � � �� " .� S�'9/°� 3. Telephone Number: -��a;�--�� G� g f�� --, .�-- �' _— � !, 4. Date of Incident: /�"�� r� � f � �' l � r �� 5. Time of Incident: /%��i rr � �r� � ��c �,� � � � 6. Location of Incident (Be specific): �''� � ,�� >c�, ��.., lii � R � ��-�� r�,-- � n� ,�.-i� �,� .�-- r� �=` �/c� r�.�' �. 1 �� 7. DESCRtBE ACCFDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give j full details upon which you base your claim. If a City employee was involved, give the �,� employee's name.) �� ,� � .._ �`7-�.�' G` � �� r sr-n f�� °z�-- �-s'¢� +� r` r��f� � �t�9� �'l �° c.e� rg 7� � � a �.�� r�,;3�,o�� i�-� �--� �, �- c- ;l! ��e l�'c� ��s: 9%.�l �',��-r��,',-` �1 �—�-rg,, "�`� �c �-C �-' �cC'� � � ,� �c��;;�; � ' . �.�.. �,. . c r ' �� ,�;� /� �c � � ; � � � �--�/�"(�.'d �''�''"�' � I� 8. What were weather conditions like? �d �c� 9. Give name and address of any witnesses: ,��,,e� ��/��-- �` L"�,c,� � �'�� `��'�� A, 10. Did police investigate? (If so, give names of officers.) �1�� f�� , 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). el/ � � Il ; � � I 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.) � � /�VG'� I;i , � !f 13. What other damages do you claim, if any? li i ; � ii 14. Have you been compensated for any part or all of your claim by any in�urance � company? (If so, give name and address of insurance company and amount paid.) 'i ;, , �a .�'.�� i , ,lCt��,�'' �� --a�r I�,,J�+�c� �.��(� I 15. What amount do you claim from the City of Dubuque? �, �,�. �,� F 8,� ,�.�,�,�� T/GP�'1',6,,'�(� � � 16. Why do you claim the City of Dubuque is res,ponsible? �'f�� 'M�h l� �� r�� 's I; �� C��t�� ..�` 'i� �'� °?� e�f�,�.r� S`�(n z�b c�/�-�''��c.� e�'i'�`�°71�� E'- ": �,r Y��t�'" �t��'� �'c�d(<.. U"t l`�� '�ra�l� �'�C'C�. � r�" ^ � 17. Have you made any claim again t anyone else for da ages as a�u�o��iisr nci��nt?�� ° (If yes,;give name and address) ,� r',�� E I� ��i �' '' /��%' f i r�i� ��: � '� 18. If the answer to Question 17 is yes, have you received any payment from that source, �� and if so, in what amount? ;i �i � ; ,i � �a#�d a# ��que, �o�� I�B� �day of ��' , 20�9 ;� (Signature) , � '�--� �`�� C� ��- ��- (Print Name) �� -,�,� � � (Rev. 5/18) �- �� c�a �;;�. � �.� �__ �� ,�� f� � � � � c� � �`` � Copyrighted March 18, 2019 City of Dubuque Consent Items # 3. ITEM TITLE: Disposition of Claims SUMMARY: CityAttorney advising that the following claims have been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool: Joseph Burbach for property damage, Hope Ehlinger for vehicle damage, Zachary Hallman for vehicle damage, Matt McFadden/ Mak's Bait Shack for property damage, Roeder Outdoor Power for vehicle damage, and Robert Sigwarth for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Supporting Documentation THE CITY OF ��.T� � MEMORANDUM Masterpzsce an the Mississippi � i � TRACEY STECK�LEIN � � � PARALEGAL To: Mayor Roy D. Buol and Members of the City Council f DATE: March 5, 2019 I ,� RE: Claim Against the City of Dubuque by Joseph Burbach � � Claiman# Date of Claim Date of Loss Nature of Claim ;� il Joseph Burbach 03/05/19 02/06/19 Property Damage � This is a claim in which claimant alleges that the Water Department mismarked the � location of the shutoff valve to cla;imant's waterline causing additional excavating expense I to claimant. 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 Denise Ihrig, Water Department Manager �,� Joseph Burbach , J � � � s OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)583-4113/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org �