Claim by Grand Opera HouseCLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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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. ~It,~/ _ {~
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The claim must be filed with the City Clerk at City Hall, 50 West 13`h St., Dubuque, IA 52001. It will ther{~t ~j('gj~v duo ~a
the appropriate department for investigation and to the City Attorney's Office. Once that investigation is comple, 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 toJ~whether your claim! wIill or will not be paid.
1. Name of Claimant: ~~r/:t,U1(." ( ~/DL'rf,~'.~/~"f('%1.I5~~ >
2. Address: ~ 3Jr !.( ~. ~ )~_ ~"~. L ~ i a ~t : C~1 t,~ l`' _
3. Telephone Numt
4. Date of Incident:
5. Time of Incident: / G =GNU ~M -- -') ~C`C' 1"' kl
6. Location of Incident (Be specific): C31~ Wit` ~.`1~=:~,.i f '!! 1 ~-' ~ `.a i %; (-'!a Cz L.~
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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.)
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8. What were wea{her conditions like? f•f~ ~ w. , °~u ti' i., ~f
9. Give name and address of any witnesses: ,j T ~~~~ (<-~ ~ Tf-{tr E~ 11'1- .~ E- (~4~ ~ •~,t l ~' . ~~' . ~~ ~ " N ~ ~~
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10. Did police investigate? (If so, give names of officers.) ;;c, - err: Z - r a 3c
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries.)
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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.)
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13. What other damages do you claim, if any? ~c!"~-~-IC-t. ti(~~~ lF k_ _ L ~l /~-~ c~5")
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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.)
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15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible? f ~~`~ i.tl..'- K h;C a ~`, r` L I (-~
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'tom tU'~~'I _,~~ t_ ..i (~ (. U t l ~ i T ~,i F~ L, , i (-1-t~ (? i T"Lt ~ F!-ki.t ~_. i -
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17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and
address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
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Dated this ~ day of I\, (. 1,< k. It.l ~~c-T=- , 20 ~ ~ .
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(Print Name)
November 19, 2008
City of Dubuque
City Clerks Office
Sue Winter
50 W 13th Street
Dubuque, 52001
Dear S e:
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In regards to the flooding in the end of May and beginning of June, we were told to get
all invoices gathered for the damage and clean up of the Grand Opera House and we had
our final invoice come in this week.
Enclosed you will find the invoices from Conlon Construction and ServiceMaster by
Banfield to be paid by the City of Dubuque.
Should you have any questions or concerns, please feel free to contact me at 563-588-
4356 or by email which is director(a)~the rg_ andoperahouse.com.
Sincerely,
/`
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John Stuff
Executive Director
The Grand Opera House
www.thegrandoperahouse.com
Business Office 135 W. 8th Street • Dubuque, Iowa 52001 Box Office
(563) 588-4356 Fax: (563) 588-3497 (563) 588-1305
SERVICEMASTER by BANFIELD
SEVEN HILLS
P. O. BOX 832
DUBUQUE, IA. 52004-0832
Bill To
THE GRAND OPERA HOUSE
135 WEST 8TH STREET
.DUBUQUE, IOWA 52001
ATIN.: JOHN STUFF
Invoice
Date Invoice #
6/4/2008 4942
Ship To
P.O. No. Terms Due Date Account # Project
6/4/2008
Description Qty Rate Amount
CLEANUP OF SEWER BACKUP MAY 30 & 31, JUNE 1
** ENCLOSED INVENTORY LIST OF RUINED/DISCARDED
ITEMS ** 1 977.75 977.75T
Sales Tax (7.~%~ $68.44
Tota I $1,046.19
Payments/Credits $o.oo
Balance Due $1,046.19
Phone # Fax #
563-557-7459 563-557-9508
SUN •~ ~. `~g~j~
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JUN 3 0 2008
INVENTORY LIST AFFECTED BY SEWER BACKUP AT
GRAND OPERA HOUSE
59 VARIOUS GALLONS OF PAINT
12 18.3 LITERS OF PAINT -VARIOUS
11 VARIOUS PIECES OF PLYWOOD
9 PAINT ROLLERS & HANDLES
8 PAINT PANS
4 QUART SIZE PAINT CANS
8 PAINT BRUSHES OF VARIOUS SIZES
1 70 # SAND BAG
1 ALL PURPOSE ROLL OF PLASTIC SHEETING
4 MIL/ 10 FT. x 100 FT = 1000 sq. feet INDUSTRIAL
GAUGE
1 MUSIC STAND
CONLON CONSTRUCTION CO. • P.O. BOX 3400 • DUBUQUE, IOWA 52004-3400 • (563) 583-1724 • FAX (563) 588-2890
Grand Opera House Date 11/18/08
IN ACCOUNT Attn: John Our Job No. 6853
WITH 135 West 8th St. Your Order No.
Dubuque, IA 52001
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Invoice No. 6853-1
Terms: Net Upon Receipt
1 1/2% after 30 days
GRAND OPERA HOUSE
July, 2008 Costs for Water Leak/Door Repair $572.00
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{'orstruction Management Association otAmerica
INVENTORY LIST DAMAGED BY SEWER BACKUP AT THE GRAND OPERA HOUSE
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59 Various Gallons of Paint i _ ~ $600 00'
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_ 18.3 Liters of Paint -Various ~ $300.00..
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11 _
Various Pieces of Plywood
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~ $13 00 0
9
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Paint Rollers and Handles
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! $30.00
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8, __ _ _
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Paint Cans ___ ' $40. 0
4 _ Quart Size Paint Cans $30.00'
8'
---- - Paint Brushes of Various Sizes
$50.00
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70# Sand Bag $0.00
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4 _
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All Pur ose Roll of Plastic Sheetin
p - 9 -
Mil/10 ft. x 100 ft = 1000 sq feet Industrial Ga
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uge
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$5.00
$20.00
1 '' Music Stand $315.00
118+--- ~
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-_ - _ $1,520.00
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