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Claim by Steve Lang tl �� , � � CLA1M AGAlNST THE CITY OF DUBUQUE, IOWA t�a �� This written report constitutes your claim against the City of Dubuque, lowa. You should � compiete 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. 13t" 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 w.ill be submitted to the q City Council. You will be provided with a copy of that report and recommendation. � � THE FWAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF r� THE C1TY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU ry AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. ; � 1. Name of Claimant: -- �� -�� c�i ij ;I 2. Address: _ �,�� i �,S'�,� ��-- ';I, � . � City: � �� +�a,c:��-... State: 1�,--- Zip: ��] �'i' �� : Ij 3. Telephone Number: �t�� `�`��l`� � 'I 4. Date of Incident: C'��r�>�� g ,� �.�.. Y�9.;�� 9� _ �� 5. Time of Incident: �.,,��,c��6� : � 6. Location o# Incident (Be specific). � � �� ,� .��s'c� � �j� �- Q�9-��'1,,�--Z'� � � �`a �`�i�� „�U��S":�" �-�.� � � 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.) Y L�s '� L..��-�.6:G.r �,� i�'9�-i��"'�.,��Q��"-�.., `. el,/4-C,�S'�� '� f s� �-,�AJ >J"'i v,� � l��-�9�.-�F �,�� -�-�-�1°��u�,� ;� �'9-a.n��j �-�,�e:��,. �'-��c6- �� ,�7 � �- - �.:�``3" , �. � �,�"" � f �3»�..� �` �'�2.� �r d.� �,�-/�'l�.-�.r�� f� .,�,��: �'?�-'3-0-�., /�".,,��!-~i�� 8. What were weather conditions like? ��. 9. Give name an�l address of any witnesses: __�_/,�$-� 10. Did police investigate? (If so, give names of officers.) G��►°� ��.�t-� .��-� c�.,� �.�. �c�-�� c.��- ��J'�'� �/ �4� 'i 1. Was anyone injured? (If so, give names, addresses, and extent of injuries). � �� 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.) � J�-� �� c �-'�,� a r� , �-�=A� ��: �, � �� --- �� l��:�y �`�-�.:�,' s.1��... �►,�6�4 ��. �,�L�.�-� � °�'s�t-,°�-� s�,.� s� �1--�P��.-,� !�s � �,,��----�i/,�� - '�--� �41°,�}2�..=� 1--�:�1--.`9 � �'d�,�-�C�� J-��5 f.� �� > 13. What other damages do you claim, if any? d i 1 i� � N 14. Have you been compensated for any part or aIB of your claim by any insurance � company? (If so, give name and address of insurance company and amount paid.) � �� I� _ a ; � 15. What amount do you claim fR�.�,�.the City of Dubuque? , il �17.��n�.� �..� ,�-�.. c��..�,�.��.-�� —:�—�� ;�� ,�u 16. Why do you claim the City of Dubuque is responsible? ; 4�t,t,�:°� ��. � � ��L�'�'s s��'�.a�, �'��'l� C�1,�4�� ,�- l�`�>� i; �, '�--��,,tP�,. �`��e� � 17. Have you made any claim against anyone else for darnages as a result of this incident? (If yes, giv 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? � �j� �?#�d at ��9��q��, ls�vy�a #�is � day �ff r e , '0�. � .,��a,.�-� �,�,,-�� (Signature) � � � �` �..'v�. a.�..- (Print Name) �.�� '� �.� � �" � � � t � � �:- � � � � � � �. i �� > � (Rev. 5/18) . � � f � t i I Confidential This communication and any attachments may contain information which is confidentia! 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. . � p Confidential information may include the following: � � � 1) Social Security Number(s) � 2) Medical/Health Information ;� 3) Personnel/Disciplinary Information � 4) Bank Account Information I� 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 Informat�on 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. �� , � �� `�� l� Sign�#ur� �at� �-1- � j 3 � � Copyrighted July 15, 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: Steve Lange for property damage, Garry and Julie Redman for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Council ATTACHMENTS: Description Type ICAP Referrals Staff Memo THE CITY OF ��.TB E MEMORANDUM Mctstel�aiece Qn tlie Mississippi � ;� TRACEY STECKLEIN /U" � PARALEGAL � � 8 r To: Mayor Roy D. Buol and ` Members of the City Council DATE: July 2, 2019 I RE: Claim Against the City of Dubuque by Steve Lang �, j Claimant . Date of Claim Date of Loss Nature of Claim �' i� Steve Lang 07/02/19 Ongoing Property Damage ,�, �i This is a claim in which claimant alleges that claimant's basement walls have been u weakened and are in need of repair due to heavy traffic and lack of maintenance on � Jackson Street. � This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Cornmunities Assurance Pool. cc: Michael C. Van Milligen, City Manager Gus Psihoyos, City Engineer Steve Lang 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/Fax (563)583-1040/EMai� tsteckle@cityofdubuque.org