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Claim by David and Connie Cole Copyrighted August 5, 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: David and Connie Cole for property damage, Dave Hubanks for vehicle damage, Mason Kobliska for vehicle damage, Robert Monthey for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo � �� � , �� � CLAIM A�AINST THE CITY t�F L}UBUQUE, �{�WA ������,� �t�'�5 ������� i This written repflrt constitutes your claim,ac�ainst fihe City of Dubuqtae, Ic�wa. Yo�- ho�ld �- � camplete #his form in fu11 and afitach any additional information that suppor�s your c�aim. � The Claim must be filed wi#h the Gity Clerk at Ci#y Ha1t, 50 Vil. 13t�' �t., Dubug�e, IA 5200't. It , will then be referred by the City Council ta the appropriate department fc�r investigatic�n. � C}nce thaf investigation is completed, a reparfi and recommendation will be s�bm�ffed to t�� � �ity Council, Yau will be prc�vided with a ct�py af that report and reccsmmendatic�n. TH� FlNAL DECISItJ� U�1 ALC. GLAIMS IS MADE BY THE CITY CQUNCIC�. i�0 EMPLOY�E tJF THE CITY OF DU�llQUE HA5 THE AUTHC�RITY TC} MAKE ANY REPRESENTATIC}N T(3 YOU AS TCJ WHETHER YC}Ut� GLAIM 1NILL OR W1�L NC}T BE PAID. � e ,�~ a "�. Name of Claimant: _:, �_r�. a�� i � � �e� �. �;� 4.�� �.�;� ' 2. Address: � �: �t r�� ���'". � City: ���.�. � State: ��.,� Zip: ��...�t�� i I < i 3. T�I�phone Numbei-. ������" �:��� � /�,,� � 4. Date of lncident: '� � � �'�/ f t���� �. Time ofi Incident: � �,� � � '��~ � � ' �� � �.. ���� ;, � , , , � �. �ocati�n of Incident (Be �pecific). ��e,��-�,����_ t���G�-�- ���`�a�r^ �� ��„��.���:��,.�" �'� ` ��� ` �.� � �� ; ; . . . .. . . . . . E 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY C�R DAMAGE. {Give � fu11 details upon wh�ch you base your claim. If a City employee was invalved, �ive tl�e ; employee's name.) .. , ��'' Cd� �"t�,. ,� ,, � , ° " �, ��r' Y �� �.� ���f� �;�.� �v��s-�i�°� �� ,��� e�-- �..��,�~ �.�� �~� �- 11.� � ��-.� ��-���y�r-�c � �� _ �-���. � �i c�. w����.� �.��.� e�a.11� � ��i,���. � �.,.���� c�� ����#� � �j�� �b�v.�?��B��e.� �/taC��6� G>�t�e��r�dt,� f��'d��. �"���'r�s �d°� ��.�c,� '� -�-; ���...�. a at���� �:,�'� , 8. V11hat were wea�her condi#ions like? �-.�� �� '�S � e���d.���. ��`e��i ��em��s�=�. ; �-��..��^- ���w���— ��. �� ���� ��� ��r ��..� �..�.- 9. Give name and address. o�any witnesses: ` ��- ,� ' '�0. Did police investigate? {If so, give names of officers,) I�, �� 11. Was anyone injured? (If so, give names, addresses, and extent crf ir�juries). �� � � E � � 12. Was any damage done �o property? ([f sQ, describe prc�perty and the extent of � - damages. Attach estimates af damages ar describe �basis for ascertaining exter�t of � � � damage.} � � ���.1 � Gt.�- .5 � �+..t� l' �t Yt „i L..i��I�e r,�..v+�. ���a�' �r' �.�-ed-c�. �.� �1°..�c:.���'�� b L� ��a-�r'�� .� �°. � r� � � '!3. What other damagas do you claim, if any? ` d $� �� _ � �"�-- t � ���' ; ��t�`tl 3 U�'.. ��'��� �i �.t.�.5 � �'e����Y'1����e,�'"' t��d� v� r"r�u-�8 ,�� �t�� �c� "�i t�'r�.:���� � (i' J t ' ��.�� � 14. Have you been compensated for any par� or all of your claim by any insurance � company? (If sa, give nam� and address of insurance company and amount paid.) � ;� �� � � � 95. 'J'dh�t�rr�c��:�� d �c��; ;,aa�er fr�� the ��fi ����t��rqc;�? ' f � � n,�i � �_�. ,� � �. �. i .,�` t' � �' t c: II _ _ �.. "-�".� �'�,t���cc i� � !! 16A iiVhy do yoe� clairn the City of Dul�uque is respon ��Ee? �a"� r 5 � '17. Have you made any claim against anyone e�se for damages as a resu[t of this incid�nt'? � (If yes, give name �►nd address.} � � � k l 18. If the answer to C�uestion 17 is yes, have you received any payment from that source, � and if so, in what amount? � � � ; � � L�ate� �t D�b�q�a�, I��a ths d�;� s�f ��... , 2� �� � �:� � �t..� �-� (Signatur�} � � ��t,.r,� � (� ��'� `� (Print Name} /��e`�.- (�... � � � � � �-�° i P � ��� � � � � � � c � .� � �' � (Rev. 5/18} . � �" �' �; �� � �" � •� C..J � � c� � Copyrighted August 5, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: David and Connie Coleforpropertydamage; Dave Hubanks for vehicle damage; Mason Kobliska for vehicle damage; Robert Montheyforvehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Cole Claim Supporting Documentation Hubanks Claim Supporting Documentation Kobliska Claim Supporting Documentation Monthey Claim Supporting Documentation THE CITY QF J,. ��T� � MEMORANDUM 1Vlc�sterpiece on the Mississippi TRACEY STECKLEIN � PARALEGAL To: Mayor Roy D. Buol and Members of the City Council !; DATE: July 29, 2019 RE: Claim Against the City of Dubuque by David & Connie Cole Claimant Da#e of Claim Date of Loss Nature of Claim p! �I David & Connie Cole 07/29/19 07/02/19 Property Damage � i This is a claim in which claimant alleges that a City sewer line backed up into claimant's i basement at 350 Edith Street. 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 Denise Ihrig, Water Department Manager Arielle Swift, Assistant Public Works Director David & Connie Cole � � 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/EMAi� tsteckle@cityofdubuque.org