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Claim by Paul _Nancy Kaufman
BARRY A. LINDAHL, ESQ. ~t)~ ``~" CITY ATTORNEY ~ o MEMO cc~~„~ 2s c ~ `~ To: Mayor Roy D. Buol and ~' Q 3 ~ Members of the City Council ~ ~ cx~ ~ c~ DATE: April 5, 2007 ~ tO RE: Claim against the City of Dubuque by Paul & Nancy Kaufman Claimant Date of Claim Date of Loss Nature of Claim Paul & Nancy Kaufman 04/05/07 03/07/07 Property Damage This is a claim in which the claimants allege that the basement and garage of their residence located at 555 O'Neill Street sustained water damage due to a watermain break on O'Neill Street. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. BAL:tIs cc: Michael C. Van Milligen, City Manager Jeanne Schneider, City Clerk Bob Green, Water Department Manager Paul & Nancy Kaufman 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 balesq@cityofdubuque.org 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. s ~- /1/Q~c ,~ ~' 1. Name of Claimant: ~C~(.~ / ~a-u~ma-Yj ~{ Q ~ ~ j'1 2. Address: ~~~J/~/ Q ~/v~1 `~ sT. ,O~( ~G~~C(~ .~~ 3. Telephone Number ~6 ~~~~-~d '~JE~S~ C~ ~~ ~~ucu ~t~/~~i~c~s ~`iaKS 4. Date of Incident: ~c~/~c-~ 7, ~~C 7 5. Time of Incident: Gt/~~rSC6V~r"~~-(-ctr'~ccn~ 9-aC~~'~'( 6. Location of Inciden (Be specific): ~,~ n~ ~ ~ c' r32~~m~nf /~ v~ 1 a 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.) ~r~- /~ t~~ ~'E' !' C cZr1'L L' ~ u.~ 07'' ~' l,J o ~'~o~ >"~ ~r`~c ~ !l S r il. D cc ~^ n, ~ ~ .. n ~ j'W ~` v1 ~ ~ ~n.~e~,~o i~~ - f~v~ < ti i11 to i7 f' ~ d_ /~ 4 y'd ~ l By' y//Jt ~ t r.~J I'E a /` t~ to us T' Qf ~'hEr~ !~ h ~~~ a l a r N u~a~`'~/' f'YIu ~n ~ rEC~ 8. What w re Bather conditions like? CQCcs f~9 a-S~iv~ y` /,`vie ~ ¢'loaoe.rr~ - C~`~arou,rtd ,~4° Cl~zr ni~`2~ .9 Give name and address of any j- _5lo S ~6o2~'J i ~~~ a m ~t n c~dd ~ 10. Did police investiga e? (If so, r ~~ t '~~ ~~ ~ y`~a ~~ gives of officers.) Spv 11. W ~ ~~nyone 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.) // / °~~ , ~~` ~u~Es S SC-'~ ~CC. c!2 cC. ~ ~~ u1 ~ l ~~' / .Z~c~ ,.( ~~; ~ s v1~ ' nti~. --~' m ~,fcr ~. ~ ,~ Pte. ~-~!~' cxx~.ds ~r©,~ r.~~-l'~r~ s~t«i~,~~t ~ I~~~ a~` t-G~~~l~o~ f~`~~S a.~^~~u~/o~~t~`~~ 13. What other damages do~iou cTairiS;'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 amourtt paid.), /d 1~'LSui^a-~'t.ce Co~/E~-9~ 15. What am unt do yo claim fr m the City of Dubuque? ~ ~.93~. T.S ur^~s ~ n ~n v~ ~o~a 16. Why do you claim the City of Dubuque is responsible? s -~'I oa i^ ra ~ n ba.c a..s cZ s - ~~ ~~ UJa'F'~ c+~ o c°_a 17. Have you made any claim against anyone else for damages as a result of this incid~? (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 this --~-~-- da of ll p/'i ( ~ 20 ~ 7~ ~~ '~~~nqn~ a~i~l4 s,;1~a~7 ~!~ (Signatur /> 9~ :~ Nd S- Ada LO ~~t ~ }C~2.LCj ~ Q ~ /l~~zn c ~~~a ~ (Print Name) Q~~~~:.~~~