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Claim by John Koenig Copyrighted November4, 2019 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Jerome Ehlers for property damage, John Koenig for property damage, George Langas for personal injury, Julie Rupert for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Ehlers Claim Supporting Documentation Koenig Claim Supporting Documentation Langas Claim Supporting Documentation Rupert Claim Supporting Documentation �� . �g e CLAIM AGAINST THE CITY OF DUBUQUE, IOWA 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. i THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF j 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: ,��'�V'1 �C�c'.�°1(� a , � 2. Address: �-�� '��."ti�� -�"' �� i � i City: � ,°' State: 1.�('�t ��... Zip: �� j , � � I 3. Telephone Number: �� "� �J�-� ��`� '' �� I� �.�� i 4. Date of Incident: _ �,j'�'��'' . )� , ; ''i �� 5. Time of Incident: (,�.,r�1,.�' ��r��`Yl ;� ,i 6. Location of Incident (Be specific): �-�'<�' �'1C'.,�� ' �if�(a�'t�Y�1 G�..�'1r1 ��c.� I �cz.�jt��,�, �� , �; 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.) e . y ��. b�'C�"-ln �b�c�t'L� C�,r-��;�-��ati� ��rt.�- � �Y"c..�� .�-�i�1cz►�� l� C�.oiP'iC�C'-�' f�l��k'.� �� . . , � _ a �, I'.f_��Y"Yt� ��i'�I'�'1 ('�`�1Pfi' fzi��l'1f��`II�" �''��fLf�11'Y� /�.'°�t�'i' L�i'� �i(:t!"'X�'1 y �v'1C�r"7t�� 1_D')� ✓��e€'Er"),, �li t��c� ��(l�r�-I�°�r'� ��,�°�►�s�� i,��n�- t�1� �rr��=n 1�1��r�� ..�P �r-r�sn 1��.�r� ' � 8. What were weather conditions like? ��(�"1 I 9. Give name and address of any witnesses: �IT�1 �=r��ri�, , ��'1t��rt 12.t3 i°v� �'m•t,�,'�� '`Il Z°Zi2 ��'�ri�rs; 10. Did police investigate? (If so, give names of officers.) , i'1 - �'-,�-�s ��.�__�- i�:�►(�<� rr��„�� n�� t�S�� Y-,r� e�$-.:�',5��" n��e��h►-`�'� ---,- 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). �� @ � Confldenfiial Th'ss commun�cation and any attachments may contain information which is confidential and privileged by �aw and is for the use of the designated recip6ent. If you are not the � intended reeipient, you are hereby notified that yau have received this eommunication in ; error, and that any review, disctosure, diss�rninatic�n, distribution or cc�pying of its contents � is prohibited. Please natifiy City of Dubuque immediately by telephone at (563}-589-412p of � your receipt of these items and destroy the communication and any attachments imrnediatety. Further dasclosure of this inft�rmation may violate sta�� and federal restrictions. , � � 7 Confidential inform�tic�n may include the fo#louving: � �) Saeial Security Number{s� ; 2) Medica[1Health Informatian ,;� 3) Personr�el/Disciplinary Intormation � 4) �ank Account Informat�on � „ 5} Financiallnformation �} Credit Card Numbers If any documentation you desire to submit tc� the City af [�ubuque contains any of the items-above � �his ccrver sheet must be at�ached directly �c� the confidential informatic�n �nd indicate the type of � infarmation that is included. �� I, ��1� �C��'� t , hereby certify that the attached documents incl�de the followinc� p tected infarmation: '�� Social Security Number(s) �� Bank Account Information � �� MedicaUHealfih �r�fc�rmation �� Financial Inft�rmatit�n � � �� Personnel/Disciplinary Information �� Credit Card N�amber(s} � '� I understand that this ir�formation may be distributect within the City ctrganizatic�r� c�r to agents �fi the � City f�,r �ruv��rg ��d I h�r�by �Uthc�riz� th� City ta act �cc;r�ingly taking a�� re�a�tt��r�� tc� � prt�tect my informatic�n from unnecessary distribtation. ��- ��-�� ignature Date � � � � 12. Was any damage done to property'? {If so, describe praperty and the extent af damages. Attach estimates of damages or describe basis for asc�rtaining ex�ent of damage.) { ' � � �� `° ~�� ,i� � �� tt�� '� � � ,; � '13. VYhat other damages do yau claim, if any2 �C�� .�� l �t,�.� 't`�°° � � � � 14. Have you been compensated for any part c�r all of yaa�r claim by any insc�rance � company? {1�so, give name and addres� of insurance cor�pany and amount p,aid,} '� �� 1 a. W�at amour�t do ou claim from the Cit of dubu u�? � Y Y q E, �I, -� -�-� _��r��.� � ��- � � �16. Why do you claim the City af Dubu�que �s responsible? ; �:i�� "C�f��` �°- �$.�"��€"� �°�''�,tr� ��yt"�� 17. Have yau made any claim against any+�ne else far damages as a result of this incident? ' (If y�s, �ive name and �ddress.} � �� 18. If the answer tc� Questi�n 17 is yes, have yc�u rec�ived any payrr�ent from that sc�urce, � and if so, in what amount? a a � ,� dated at ��bu ue fowa th9s �� da c�f � � �0 ��. � q , 3� _�� B � � � �,�-�'�'"....�._._ .,.,.,�"�,,,�-� {S�gnature) � � ��t�`, �' {Prin� Name} � C� � �� ,� � � �� (Rev. 51'I 8) �� :.� "=- � � � � � c-� � � � � � Copyrighted November4, 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 forthe IowaCommunitiesAssurance Pool: Jerome Ehlers for property damage, John Koenig for property damage, George Langas for personal injury, Julie Rupert for vehicle damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo Dubuque THE CIT'Y C?F � '� All•Ameriea City � �� N�ai�irnt�Gxrc:��: 1' Il�or Masterpiece on the Mississippi 2oi7*zoi� i � TRACEY STECKLEIN F�ARALEGAL ' '�, '; MEMO ' To: Mayor Roy D. Buol and Members of the City Council ',� DAT�: October 24, 2019 � � � � !I RE: Claim Against the City of Dubuque by John Koenig I� Claimant Date of Claim Date of Loss Nature of Claim 1 John Koenig 10/23/19 09/12/19 Property Damage ;I �l This is a claim in which claimant alleges that construction being performed at 22nd Street !� and Kaufmann Avenue caused his home at 2210 Francis Street to flood. �' � 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 ! Gus Psihoyos, City Engineer �i Deron Muehring, Civil Engineer II John Klostermann, Public Works Director � John Koenig � 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 � �