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Claim by Mak's Bait Shack / Matt McFadden 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 8 �� C�,�� . CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ��1�'-�"�,.� ; This written report constitutes your claim against the City of Dubuque, lowa. You shouid complete this form in full and attach any additional information that supporfis your claim, The Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001. It , will then be referred by the City Council to the apprcapriate department for investigation. � �2��e th�# �r�•�o��igato�sr� �� ovple#�d, a� r�por# �r�d re�cr�r�+�ndat�or� ��9 �e �ubrnB�k#ed #a �he s Cifiy Council. You will be provided with a copy of that report and recommendation. � I�, 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 Y4U 'i AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. !� , 1. Name of Claimant: �' If�.�� ° � ' �, G � �I� s I�' 2. Address: �`�� 10�rR n �; City: �J � �� ,l State: ��- Zip: _ 3, Telephone Number: ��,�=��i��,�: �4. Date of Incident: ��- � � � 5. Time of Incident: 7 a 0� �t_v'Vt � �i 6. Location of Incident (Be specific): ��a� ��'� ,1��,��l�� (9l�'.� �CA.+� ��.Gtc.�� ' i I 7, DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSIED INJURY OR DAMAGfE. (Give f full details upon which you base your clairn. If a City employee was involved, give the ; employee's name.) � �� ._ , � �..�� I�n.� �j� �..d � ��-- fi��6 �r� �7�v��° �� c�.�-� �-�°��f i�s� � � � �. ��( �c - �� . - � 8. What were vveather conditions like? A t f Ulr� . �°�1� � i 9. Give name and address of any witnesses: ��P �4�W�6' ( P ! I 10. Did police investigate? (If so, give names of officers.) ; � ��' r 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). � I � 12. Wa5 any damage done to property? (If so, describe property and the extent of � damages. Afitach estimates of damages or describe basis for ascer#aining extent of damage.) �� i � � "�. �< �� `� i �I � �� 1S, What other damages do you claim, if any? �i�''W� � � i� 'i� '14. Have y�ou been compen�ated for any part or all of your claim by any insurance ;i company? (If so, give name and address of insurance comp�ny and amount paid.) � � !!, �. �� 15.^What amount do you claim from the City of Dubuque? , ��f�� 16. Why do you claBm fihe City of Dubuque is responsible? ; �n � ' � w d � -Q�l�@ � �' �I� � � � 7 17. Have you made any claim against anyone else for damages as a result of this incident. (if yes, give name and addr��s.) `��• i V� � � } � 18. If the answer to Question 17 is yes, have you received any payment from that source, � and if so, in what amount? �. � ,f Dated af Dubuque, Ic�wa this �, day of �,��,�u'1 , 2U�. � i i , � � (Signature) ` � � �� 1 VI`�1��(�101 � ) C� ' i Print Name � � �� ' �}` t, ,/ ' Y w�y� � � �-� �.. 1 ..4� r("J �r� r;,r� � � ��w I e.;� ._ � � (Rev. 5/1�) �' � �= � ' <� � I , ; �� , ; � ; � I 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� E MEMORANDUM � Mc�sterpiece on the Mississi�pi � TRACEY $TECKLEIN �� PARALEGAL i To: Mayor Roy D. Buol and � Members of the City Council � I i DATE: March 8, 2019 � � � RE: Claim Against the City of Dubuque by Matt McFadden on behalf of Mak's il' Bait Shack i� Glaimant Date of Claim Date of Loss Nature of Claim Matt McFadden 03/07/19 03/04/19 Property Damage Mak's Bait Shack �; i This is a claim in which claimant alleges that a sewer backed up onto claimant's property � at 2095 Kerper Boulevard. � 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 I Matt McFadden, Mak's Bait Shack � i � � 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� (563)583-1040/EMai� tsteckle@cityofdubuque.org