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Claim by Michael and Casey Foley Copyrighted January 21, 2020 City of Dubuque Consent Items # 2. ITEM TITLE: Notice of Claims and Suits SUMMARY: Michael and Cassie Foleyfor property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Referto City Attorney ATTACHMENTS: Description Type Foley Claim Supporting Documentation ��,� r��M �.1�1 �,�, CLAIM AGAINST THE CITY OF DUBUQUE, IOWA � �o�y� ; 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. i ; 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. '1! 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. 4 li 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 '�I AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. I; , ,�,,,� ;I 1. Name of Claimant: 1�., , � i �� ,q I 2. Address: ��j ,d�'f�.,`�� '�`1�'�..-` i �; � �; City: t.�tJl.�l��ll�' State: �� Zip: ��(7 ) � , V �„ !j 3. �'��epho�6 RE�arro�er: �",/�� i� �� ii ii ;.�� 'i �4. Date ofi Incident: 1,,��YY1��,� �� , �� q n ,r� �; 5. �ime of Incident: f�"�� 1�� , � � `t��"�l " � �� ij ` li 6. Location of Incident (Be specific): ��J�j� ��(�r� �1( 1�"� ; 1�.., � �J�1�� a� �� i 7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give j full details upon which you base your claim. If a City employee was involved, give the � employee's name.) � ��1Q�' Q.� �`�'2�-�` ��Q.C..k� � > ��" i�.� � ; ;5 i ` �� . �` �.6 , � c� ��I � b u �fU�,�r � N 8. What were weather conditions like? `' �✓�1G� � � � 9. Give name and address of any witnesses: '�+►C.��1 1 ��fLR._+ 10. Did police investigate? (If so, give names of officers.) �� 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). ,� A W'1`D � � � 4 � � 6 � � � �k 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 i��in�_(;�� u � �� 13. What other damages do you claim, if any? I �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 1f1b il � 15. What amount do you claim from the City of Dubuque? li `��31� C1 �plD <° �� ve,�i�a.t��✓' lr�� i: �II 16. Why do you claim the City of Dubuque is responsible? , i� �� n�� C;�+�� 1 i Rt� i rx.s �I� c;� . � '�c.� S e��l�r�l i� ►�- � � ` �� u� �,�� ' �p��,�--rat—��; 17. Have you made any claim against anyone else for damages as a result of this incident? ', (If yes, give name and address.) � l�1� 'i; , 18. If the answer to Question 17 is yes, have you received any payment from that source, '; and if so, in what amount? ,� � i; i', � ,,,,... - I Dated at Dubuque, lowa this �day of �. , 2p�� ,� �� y^ �,,,�- ��..,.- �� _��,�,( �v� 1� �.�°� (signature) � �' , �� '� � �""�-� (Print Name) ' � � � � �� C� � � � �' �` � a � (Rev. 5/18) � � � � � � '� �' � � � � � n � � 9 � I i Confidential ' This communication and any attachments may contain information which is confidential il and privileged by law and is for the use of the designated recipient. If you are not the I; intended recipient, you are hereby notified that you have received this communication in I; 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 i, your receipt of these items and destroy the communication and any attachments �' immediately. Further disclosure of this information may violate state and federal ,y restrictions. I; N incl the followin : � Confidential mformation may ude g , 'I 1) Social Security Number(s) 2) Medical/Health Information I! 3) Personnel/Disciplinary Information �I 4) Bank Account Information � � 5) Financiallnfiormation � � 6; �redit �'�rd NambPrs �'{ � 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 ; u �� I, , hereby certify that the attached documents f( include the following protected information: ' Sociai Security Number(s) Bank Account Information , ; Medical/Health Information Financial Information � i; ,� Personnel/Disciplinary Information Credit Card Number(s) �'i il 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. � � �. � Signature Date � � �� a � k � � Copyrighted January 21, 2020 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: Michael and Cassie Foley for property damage. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Concur ATTACHMENTS: Description Type ICAP Referrals Staff Memo �ubuque e THE CITY OF q �II-A�eriea Ci� � � 1.J � � �,x��,..�a��; ,'I I '°r Masterpiece on the Mississippi Z017*2019 � � �� TRACEY STECKLEIN �p � PARALEGAL �J,� P MEMO �I g y i � To: Mayor Roy D. Buol and 4 Members of the City Council �� il � DaTE: January 6, 2020 ;� J RE: Claim Against the City of Dubuque by Michael & Cassie Foley ',I �I Claimant Date of Clairn Date of Loss Mature of Claim ; i Michael & Cassie Foley 01/06/20 12/29/19 Property Damage I ,� This is a claim in which claimant alleges that a City sewer backed up into claimant's j basement at 2353 Martin Drive. � �� This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. " i � cc: Michael C. Van Milligen, City Manager �� John Klostermann, Public Works Director �'i Michael & Cassie Foley � � @ 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/Ennai� tsteckle@cityofdubuque.org