Claim by Carol McDonald Copyrighted
May 6, 2019
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Konstantine Batonisashrili for vehicle damage; Nick
Hermsen for vehicle damage; Kassandra Jacobs for
vehicle damage; Carol McDonald for property damage,
Aiman AI-Qady vs. City of Dubuque Housing Board of
Appeals.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City
Attorney
ATTACHMENTS:
Description Type
Claim by Konstantine Batonisashrili Supporting Documentation
Claim by Nick Hermsen Supporting Documentation
Claim by Kassandra Jacobs Supporting Documentation
Claim by Carol and Charles McDonald Supporting Documentation
S uit by Ai man AI-Qady S upporti ng Documentati on
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M�.I M
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA �� K���"`n
�,�yoS
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 City Hall, 50 W. 13th St., Dubuque, IA 52001. It
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
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.
1. Name of Claimant: � �� � � �r�
2. Address ,�;��,°Z �,/�'s�:l,L,�� �
City: State: �,� . Zip: ,,��4 Q
3. Telephone Number: J`�(r, � - �'��'j�- s�'$ �
4. Date of Incident: ,C,/- /3 �- / �'
5. Time of Incident:
6. Location of Incident (Be specific): __,��� �,� � .� �'��,��
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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.)
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9. C.�iv name a r-ess�,p' y�tnesse • - �,-1.�s
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10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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
dam age.) ��!e��7 t�•.�JZ.�.�Q.�CG�7-C`.� --�,2/��d✓ c��?--lh�-Z�t�C�'i"? .
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13. What other amages do you claim, if any?
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14. Have you been compensated for any part or all of your claim by any insurance
company? (If so, give name and address of insurance company and amount paid.)
� 15. What a ount d u claim from the City of Dubuque?
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16 hy do,you claim the City o Dubuque is responsible?
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17. Have you made any claim against anyone else for damages as a result of this incident?
(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?
Dated at Dubuque, lowa this � day of , 20��
l���/�L'�-� ��'/ G���C�` (Signature)
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Confidential
This communication and any attachments may contain information which is confidential
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 immediately by telephone at (563)-589-4120 of
your receipt of these items and destroy the communication and any attachments
immediately. Further disclosure of this information may violate state and federal
restrictions. .
Confidential information may include the following:
1) Social Security Number(s)
2) Medical/Health Information
3) Personnel/Disciplinary Information
4) Bank Account Information
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
information that is included.
�� , hereby certify that the attached documents
include the following protected information:
Social Security Number(s) Bank Account Information
Medical/Health Information Financial Information
Personnel/Disciplinary Information Credit Card Number(s)
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.
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Signature Date
� �
Mr.Rooter Plumbing Of Dubuque Invoice 54015975
5085 Wolff Road Invoice Date 4/13/2019
s Dubuque,lowa 52002 Completed Date 4/13/2019
� � (563)583-5080 Technician Donald Green
Customer PO
Billing Address Job Address
Carol Mcdonald Carol Mcdonald
3362 Venture Court 3362 Venture Court
Dubuque,IA 52002 USA Dubuque,IA 52002 USA
Description of Work
Complaint water in utility room.
�ound the sewer backed up in the basement. Pulled the toilet and ran the 2001 type cable machine through the access.
Made several passes with multiple cutters and could not get passed 80-90 feet. Pulled the manhole outside and found
some sludge in one of the outlets.Came back 4/13 and chiseled off the clean out cap in the front of the house and found
the water gone. Ran the camera and pushed to the manhole at approximately 68 feet. Found the piping built up with what
looked like cement,found loose scale and ledges throughout. Ran the Trailer Jetter through manhole and made a pass up
to the house and could not pull back under pressure due to bwld up at the inlet.Worked the inlet area and could not
remove debris. Line is open and flowing at this time and will back up again due scaling and the inlet closed up under 2
inches.
Recomend fixing the line at the manhole and recondition piping.
Use disposer to a minimum and use Angel soft toilet paper.
Task# Description Quantity Your Price Your Total
C1215 Mr.Rooter will attempt to cable a line thru basement access to clear stoppage for up to 1.00 $220.60 $220.60
2 hours.All services include a complimentary whole house plumbing safety inspection.
This includes a 30 day warranty for tree roots only,does not apply to grease,paper
towels or foreign objects.
C01230T Hydro-Scrub High pressure (2 Hour minimum) Trailer Type Machine up to 1.00 $593.60 $593.60
#4000psi @18 gpm
Paid On Type Memo Amount
4/13/2019 MasterCard $871.19
Sub-Total $814.20
Tax $56.99
Total Due $871.19
Payment $871.19
Balance Due $0.00
Thank you for your business.
IMPORTANT NOTICE:You and your service professional are responsible for meeting the Terms and Conditions of this cont�act.If you
sign this contract and you fail to meet the terms and conditions of this contract,you may lose legal ownership rights to your home.I
agree that initial price quoted prior to the start of work does not include any additional or unforeseen tasks,nor materials which may be
found to be necessary to complete repairs or replacements.I also agree to hold Mr.Rooter Plumbing�or its assigns harmless for parts
deemed corroded,unusable or unreliable for completion of stated work to be done.I hereby authorize Mr.Rooter Plumbing�to
perform proposed work and agree to all agreement conditions as displayed and further acknowledge that this invoice is due upon
receipt,Independently owned and operated franchise.Amount to Authorize:$871.19
4/13/2019 � C � un --"
Acceptance of work performed:I find the service and materials performed&installed have been completed in accordance with this -
agreement.I agree to pay reasonable attorney fees,collection fees and court costs in the event of legal action pursuant to collection of
amount due.Total Due:$871.19
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Copyrighted
May 6, 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: Konstantine
Batonisashrili for vehicle damage, Nick Hermsen for
vehicle damage, Kassandra Jacobs for vehicle damage,
Carol McDonald for vehicle damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Staff Memo
THE CITY OF
4,.J � �.../� � � M o 1\ � 1 \ � LJ � �
Master�piece on the Miss�ssippi
TRACEY STECKLEIN .��
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DaTE: May 1, 2019
RE: Claim Against the City of Dubuque by Carol McDonald P
I�
Claimant Date of Claim Date of Loss Nature of Claim ,�
!i
Carol McDonald 04/29/19 04/13/19 Vehicle Damage I�
,h
�,
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This is a claim in which claimant alleges that a sewer backed up into claimant's residence '';;
at 3362 Venture Court due to a blocked sewer line.
I
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 Klosterrnann, Public Works Director �
Arielle Swift, Assistant Public Works Director
Carol McDonald '�
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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