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Claim by Mike and Jeanne Duggan Copyrighted August 19, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Susan Beckman for property damage, Mike and Jeanne Duggan for property damage, Brian Feldman for property damage, Bill and Kathy Miller for property damage; Tiffany Anderson vs. City of Dubuque et al. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Claim by Susan Beckman Supporting Documentation Claim by Mike and Jeanne Duggan Supporting Documentation Claim by Brian Feldman Supporting Documentation Claim by Bill and Kathy Miller Supporting Documentation Suit by Tffany Anderson vs. City of Dubuque, et al. Supporting Documentation � i IM J CLAIM AGAINST THE CITY OF DUBUQUE, IOWA J-K�� This written report constitutes your claim against the City of Dubuque, Iowa. 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. 13t" St., Dubuque, iA 52001. it wili 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 ClTY 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. 'I. Nan�e of Claimant: �1��(.� �- T��r�,� (��c�;c.r; 2. Address: (v�S � `�/Ll// �`J: City: �J v�v °v-e State: :�.wa_ Zip: _��=s` ��,.��s� 3. Yelephone �umber: �; � �� 'c� �- ��v `;�� -��r��;�'_�� .,j��'��/a�' 4. Date of Incident: �lf:� �:�c�t�; 5. Time of Incident: ��, ; �_�,�t��; <<� c�r,� r,��.,., > c<°�� i �� `�� 6. Location of Incident (Be specific): l��m f'�r� cr�t C�� } r%��t`� �-�f. 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.) . � �` � c�re�� ;�> x�� ,. ,�',:-<, v ' � �" �� , �. ,. , �0 f .�✓. .. , ,., �7 7�� ` �� /�l t'j z'r trr, ,- �,. j+,`l i. �v ___� (F�.✓�f �..�1��_`i.�,/ii li !� c'c'1•- �/i'C�'Y C,6�,J_;r (; �l.,-�- / , ,� ,.�� 'C� •c' �/(/eti l"� 1.��lil<" / �(/r�',c/r ��"�i �� '=r'�� --.�' "f s!�� 9 �Gs�:'Lv C�/� 'J�Gn, � � - i� _,�d^•-_ C��''� - -- . ..� �. . f"'r _ c ,. —..�(�� V 8. What were weather conditions like2 �'/�<<�-� �,-,� r�,� ,, : ��,�� ,��F, ,; . /!, � �`��- -� p�r l�-,�;�� 9. Give name and address of any witnesses: %f � ��; r --= ,�: ,',; �� ,� :�, .;> ��,. 10. Did police investigate? {If so, give names of officers.) /— � � c.1 ,� «, �i� j a �� _� � �� , ` '11. Was anyone injured? (If so, give names, addresses, and extent of injuries). ;� 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.) i� _ � t'f t� �.. �� , � � f - a r'i �� r �a, , r'�x�^ � r � � � � : � � � l ,� � j .� � l 13. What other damages do you daim, if any? ' �: � yc ;;e� � �,1c��r- _�-`- - �>.��,�zn , ,n i r��U� �� f'1 l Y��I r`7 Gs /'# C' c �"�'1 r� rt v" _"�", , � �-t�c�� ' � i � 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.) �;1: � ,{6,,>,-,�� -t,��;. . ,� ,, , 1' �, _ , � ;, . .�G;1 iG ?� '� - �i. P �G�,-�.. e . I �� ;d -� K �' � �l � ��7� � e`, ry� ,c�c= c.; ..�. C�a rr crT, �1�0�� ly�.-+ � � f�� r. it: {��`i C`�;,' � o'�� C.�."��:�Ic: c� .�;� i � '�' �� i�� f�P t✓rl��i;'j(i l�� C: �:��tlYd'.t f- 15. hat amount do you claim from the City of Dubuque? t =�--�-_� �.�� r . �; � ,-� ;.�, � � `.G,`r'� / o- � 16. Why do you claim the City of Dubuque is responsible? / .. ; l a� 'v i. � ;.� G J+'- {��, �.`. �� ` ,� �l.' 4�l -..C�� '��)'-R d � /!Ll - ,. . .. - -� ..� GY �� .L-l.. i�i�`i�.S t.�. : „: z r�6y (' r < '�_ = (Crv1 �-;.+ � _J . � j �_ 6 ,s e �+� �C''v_t"!� �47 f s �f 3 C"i��" � �'-Z'c-� 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) r� -{- 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 �''��`�v�--'� , 20�. ��-j � "� 'T'*n �� ;--, C� G.� �-� �� ° �` F— c� !s L`1 = � `�'C-`<c � ,��. � ,��.-�,�. (Signature) � u; � ;�-, �` �...- = I7 ��r �� °. -� � � t0�; � �-�� '��i (Print Name) , � 1 ) �'' � L_ ��iC� Gl�L �� t� C Lf'C(i1 U� T� �r�j �c, k Pr .'7 (Rev. 5/18) r �{ � / �'�::a�5 c�c,u..►,. L�i� `j�� fl �'S�1 !'►'Ici �" �ry rr� �-�'(U r C.�' 1 f'L� �`ca c I-�ct � c, \J v.,� e r� �j � ��e c l �t r ��_ p C�� p �;-� .�l�� s'v'- c��, �/V.4 e��n �t- tr�� n� �� '1.Gtv�e �� l�e 0. C�� L K-. V� l �. Ovr tr� S uran << , �/�J-� �ze � '�f�P c'c� S(,�� c�er �i> t� l� ri I� Vi/� �n_, ..�- �'T`- �n��_- ��.! �� v�Y �� P �' ('T�, C�- �P"�/. 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 6j Credit Card fVumbers 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. �� 1�� - , hereby certify that the attached documents include the followi rotected information: Social Security Number(s) Bank Account Information ^!!edicu!;H�alt" lrfcr�rati�� iriariciai inrorma'tion 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. �� /� /i � ignature Date Copyrighted August 19, 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: Susan Beckman for property damage, Mike and Jeanne Duggan for property damage, Brian Feldman for property damage, Bill and Kathy Miller for property damage SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo THE CITY QB L�U� E MEMORANI� UM M�sterp2ece an the Mississi�i � � TRACEY STECKLEIN PARALEGAL � ll � To: Mayor Roy D. Buol and t� Niembers of the City Council � fl DATE: August 8, 2019 � ! � RE: Claim Against the City of Dubuque by Mike & Jeanne Duggan i ;� Claiman# �ate of Claim Date of Loss Na#ure of Ciairra '!.I Mike & Jeanne Duggan 08/07/19 07/01/19 Property Damage ;; This is a claim in which claimant alleges that a City sewer line backed up into claimant's �� basement at 625 O'Neill Street. . li This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa � Communities Assurance Pool. � �, cc: Michael C. Van Milfigen, Cifiy Manager � Denise Ihrig, Water Deparkment Manager � Arielle Swift, Assistant Public Works Director � Mike & Jeanne Duggan u � �� 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