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Claim by Mark and Lisa Krieg
Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL To: Mayor Roy D. Buol and Members of the City Council AN L M DATE: February 7, 2012 RE: Claim Against the City of Dubuque by Lisa Krieg Claimant Date of Claim Date of Loss Nature of Claim Lisa Krieg 02/07/12 01/31/12 Property Damage This is a claim in which claimant alleges that a blocked sewer line caused sewage to backup into claimant's bathroom tub and stool. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager John Klostermann, Street & Sewer Maintenance Supervisor Lisa Krieg Cif-TICE OF THE OIT`i` AT FORNEY LDUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN SIRE FI DUBUQUE, IA 52001 =6944 I ELE PHONE (563) 583-4113 /Fix (503) 583-1040 / EMAIL tsteckIe ©cityoiclubuquE.orgg CLAIM AGAINST THE CITY OF DUBUQUE, IOWA 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 West 1311-1St., Dubuque, IA 52001. It will then be referred to the appropriate department for investigation and to the City Attorney's Office. 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 City 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. 1. Name of Claimant: A Q r 2. Address: 3. Telephone Number: (5 -Q3) - 5' -83-ap / 4. Date of Incident: 7 i e _3C..'f�rf� �J CA liaa dy 3 /, Zcl 5. Time of Incident: l : 00 7 - h 52oO3 6. Location of Incident (Be specific): 41? rOOJfrrC ° on�f� / %>, ho z5 }%D /6 S call on(' i �c< < (/ 7. Describe the 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.) I - 1 ea r d 00)5- e- -A'i M/ /rig corni - rom mile, /yew ..5&30/ qaW s2(vct <ifa_3 in v i2 BUG — 6 iii ch U slow n'ra,n; - -& -/ e, lle - /ei},viJ, ckp as%�s „;'7 Ai 8. What were weather conditions like? (. Give name and address of any witnesses: Y Y 1' • Cn� ' Z�o ��D V �Q�l�i- V {' f'/'L (Q3J a -5Oea Th k ° C,T Bt-;610-(0,-1_ 10. Did police investigate? (If so, give names of officers.) 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.) W. 11 1L0 G -(//) p/1•0-e -(se ph ) In 7 fr7 rd. V \I �i,s -k.L/ o/� A /.6.!''J, IS , 600 , , (D/r'zb r .S _(iL 5fo_e__,,, 60673 J �� f 13. What other damages do you claim, if any? Alm Tit /) rl // �'C/Ghl'C2/ l�t,•�ll Via sherd c uol / ti'a.n - d 'c� 14. Have you een compensate for any part or a lyo r c aAi § any insurance company? (If so, give name and address of insurance company and amount paid.) "8/% l /7 w mqe 2e,r,, _e . L; i Hens 1/4 d 15. What amount do you claim from the City of Dubuque? 16. Why do you claim the City of Dubuque is responsible? 777 / %e%% 7ro,Py7 S (2 (372; dam ors) /C'1G Pd -6 he, ;-es sh 06dd de (iii 6 i'ed r-e.y6 (0 /� 17. Have you made any claim against-anyone else for damages as a result of this incident? (If yes, give name and address.) Do 18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount? Dated this J day of /'y 1)/10 20 kk!. (Print Name) C) `c c CT CD CD r rn hii44%cia cm,-/-(4--/e3) C2 rs• A. c S&61 _ r f?C Gua *-o-' t —6 G,J y _ e(czbi. �- Cse w She e��M �4 -� Cd-614.,, tO_Lutc40__, /0,6_,eg _ th_L e-:(;4/ 6444_4_ . -� Co �� o -' coin Z-Mes) ZLa _ i,� i �CD cc' pt vc41' /qo , )4-J w.,,„,./L6,_ 6A sJ r_1(x 60-,) OL.,-„t_ .62/baeLidm, I. 52 �,� OW" " 7L2,/ cuLL I � -&/te, C9-63)-- S8 3 —C)C, vo %,"-rn-e C�� 6 - -3(1q8. c�.QlC -x-to