Claim by Jennifer CooperTHE CITY OF
DUB F MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: October 11, 2012
RE:
Claimant
Jennifer Cooper
Claim Against the City of Dubuque by Jennifer Cooper
Date of Claim Date of Loss
10/09/12 09/26/12
Nature of Claim
Loss of Income
This is a claim in which claimant alleges she lost income because Water
personnel shut off the water to work on a water main break at 24t" Street.
an in -home daycare provider and stated that regulations forced her to close
for that day due to no running water.
This claim has been referred to Public Entity Risk Services of Iowa, the agent
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Bob Green, Water Department Manager
Jennifer Cooper
Department
Claimant is
her daycare
for the Iowa
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001 -6944
TELEPHONE (563) 583 -4113 / FAx (563) 583 -1040 / EMAIL tsteckle @cityofdubuque.org
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) Financial Information
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.
include the following protected information:
, hereby certify that the attached documents
Social Security Number(s)
Medical /Health Information
Personnel /Disciplinary Information
Bank Account Information
Financial 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.
Date
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 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.
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:
r ,
2. Address: i'�
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
■
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.)
8. What were weather conditions like?
a
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
OcN
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.)
13. What other damages do you claim, if any?
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.)
15.4What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
\�cL 5\ ,r\ c �c .`�� �ti '4--NC ._ V \CA iC") CA
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
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, Iowa this
day of ` , 2
(Rev. 7/12)
(Signature)
(Print Name)
On 9 -26 -12 a water main break occured on 24th Street between Jackson and Washington.
When the distribution crew turned valves to control and shut off water my business also lost
water. i run an in -home daycare and immediately went and asked how long water would be off.
My mother was in my home as I was outside talking to supervisor. I was told they were not sure
but it would be awhile. He told me that the earliest the water would be restored was 8 or 9pm.
As per regulations I had to close and contact all parents to pick up their children or make other
arrangements. About an hour later the water came back on. But it was to late because
everyone had either picked their child up or made other arrangements.
When questioning the work crew I was informed that a valve at 22nd Street between Jackson
and Washington had been left closed when work was done 3 or 4 years before. Had this valve
not been left closed by the water department water would not have been effected like it was.
The Toss of income to myself was caused by the actions and previous inefficient work done by
the city water crew.
Follows is a breakdown of the income lost.
Family A pick up early 2 hours lost
Family B pick up early 2 hours lost
Family C pick up early 2 hours lost x_2 children
Family D pick up early 2 hours lost
Family E could not come for 8 hours
Family F could not come for 6 hours
Family G could not come for 41/2 hours
Family H pick up early 1 1/2 hours x2 children
Family I could not come for 6 hours X 4 children
Family J could not come for 2 hours
This totals 57.5 hours at a rate of $2.50 equalling $143.75
1
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 13th St.,
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:
2. Address:
3. Telephone Number
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be _specific„
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 nam .)
m
iNA f ' , t n
11)tart zei
Olt t,
8. What were weather conditions like?
n C
9. Give name and address of any witnsses:
10. Did police invstte? (If so, give names of officers.
11. W s anyone injured? (If so, give names, addresses, and extent of injuries).
,jc
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.)
13. What other damages do you claim, if any?
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.)
15. Wh t amount do you claim from the City of Dubuque?
16. W -do you claim the City of Dubu • ue is responsible?
17. Have you made any claim against anyone else for damages as a result of
this incident? (If s, give name and address.)
18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Dated
L
(Signature)
day of
, 20