Claim by LJR Investments LLC c/o Linsy Adams Copyrighted
October 7, 2019
City of Dubuque Consent Items # 2.
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Nick Helgerson for property damage, William Hickson for
property damage, Mary Kisting for vehicle damage, LJ R
Investments, LLC c/o LinsyAdamsforpropertydamage,
Jayantibhai Patel for property damage, Jhony Edgordo
Ramirez for property damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City
Attorney
ATTACHMENTS:
Description Type
Helgerson Claim Supporting Documentation
Hickson Claim Supporting Documentation
Kisting Claim Supporting Documentation
LJR Investments, LLC Claim Supporting Documentation
Patel Claim Supporting Documentation
Ramirez Claim Supporting Documentation
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ���L
V�,ctG.�� O.e.p�".
This wntten report constitutes your claim against the City of Dubuque, lowa. You should
complete this form in full antl attaeh any additional in(ormation thalsupports your claim.
The Claim muat be filed with the Ciy Clerk at City Hall, 50 W. 73'^ SL, Dubuque, IA 52001. It
will ihen be rehrred by lhe Ciy Gouncil to the appropriafe department for investigation.
Once [hat investigation is romplefetl, a report anC rewmmentlation will be submittetl to the
CiTyCouncil. Youwillbeprovidedwithacopyo/Natreportandrecommentlation.
THE FINAL OECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL NO EMPLOYEE OP
THE CITY OF OUBUpUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO VOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Nameofqaimant: �R S(IJQPnFments LLC ��o Linsy Adams
z. naaress: 5A?3 West �I +!'
c�ro: Du.buc���_� s�r�: T_A z�P: �,Jno �
3. TelephoneNumber, �S�D� -'� 5\�� " � PJ2,3
4. DafeoflncideM: July�� 7�1�I
5. Time of Incitlent: � OM '�. (]�O�xT
1
s. �o�ae�o� eri���aaoe �easrae�rq: 2q�1� �eusxwcck
�wb�u¢ . Tl� 5200\
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURV OR DAMAGE. (Give
full defails upon which you base� your claim. H a City employee was imolved, give ihe
employee's name.) ��.. n
R bJ(Y�PY M114 (1 �llUri9�' iCO. lasV p �QP(1(ACW �Cl OUZ KPh�TI �
hc�mE � + rP�yirocl �.r cleYln ian r�P.�.� �,��,kar hrc,FNr anC�
p���� to be ce�ai�ed �an e��acea .
e. hat ewaatherconCi[onslike? u�Yi�
9. Givenameantlatltlressafanywi[nesses: TPSY1�1fS — ZQq�J �C� eT1CWPP�C
10. Did police investigate? (If so, give namea of oKcers.)
No
H. Waeanyoneinjured? (Ifso, givenamee, adtlresaes, andextentofinjuries).
No
1P. Was any damage tlone to property? (If so, tlescribe property antl the ezten[ of
tlamages. Attach estimates of tlamagea o� tlescribe basis for ascertaining exhnt of
damage.)
�.ir.�Pr flhmr�ao 1n hf�S� mea��� �1E2.c� Q n�W W(��er
hen�P�,_('y�r1 _�re nla cF �l o �nn i
11. Whatothe� dama9estloyouclaim, ifany? �'�PlL[l—IA�_ '��
id. Have you been eompensated for any part or all of your claim by any insuronce
company? (If so, 9rve name antl atldress of insurance company and amoun[ paid.)
None
15. Whatamounttloyouclaimfl�t�,CityofDubuque?
Jb > ��
i6. Why tlo you claim the Gry of Dabuque is responsible?
I7��o to h WR4et MCs�n Y; rPn1C
il. HaveyoumatleanyclaimagainstanyoneelsefordamagesasaresultofihisincitlenC/
(If yes, 9ive name antl adtlress.)
No
18. If the answer M pueslion 17 ia yes, have you received any paymenl from ihat source,
and itso, in whatamount7
Da[etl al Dubuque, lowa lhis �1'�' day of�.P�2M'(�bef . 20�.
\XkN.iiAD 1 A ���M1L ISignaWreJ
�f15y 1 \UQYY�S (PrintName)
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(Rev. 5H8) � � s m
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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 viotate 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.
I, , 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.
E
� - � � - 1 �l
Signatur Date
Copyrighted
October 7, 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: Nick Helgerson
for property damage; William Hickson for property damage;
Mary M. Kisting for vehicle damage; LJ R I nvestments,
LLC c/o LinsyAdams for property damage; Jayantibhai
Patel for property damage; Jhony Edgordo Ramirez for
property damage.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur
ATTACHMENTS:
Description Type
ICAP Referrals Staff Memo
THE CITY OF
�� �--+ � � � 0 1` � 1 i � V �
Masterpiece on tlze Mississi�pi
TRACEY STECKLEIN
PAR�OLEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATe: September 17, 2019
RE: Claim Against the City of Dubuque by LJR Inv�stments LLC c/o Linsy
Adams
Cla�r�ar�t Date of Clasm Date of Loss Nature of Clasm
LJR Investments LLC 09/17/19 07/02/19 Property Damage
c/o Linsy Adams
This is a claim in which claimant alleges that a City sewer backed up into clairnant's lower
levei ofi i#s rental property at 2995 Brunswick Street.
This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa
Communities Assurance PooL
cc: Michae! C. Van Milligen, City Manager
Denise Ihrig, Water Department Manager
Arielle Swift, Assistant Public Works Director
Christy Reed
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/En�tai� tsteckle@cityofdubuque.org