Claim, Dolan, Joseph E.CLAIM AGAINST THE CITY OF DUBUQUE
This writtenreport 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 Street, Dubuque,' Iowa 52001-4864. 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 reco~endation.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL.
NO EMPLOYEE OF Ta~ CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY
REPRESENTATION TO YOU AS TOWHETHER YOUR CLAIM WILL OR WILL NOT BE
PAID.
1. Name of Claimant: Joseph E. Dolan
-2. Address: 1596 Atlantic Street
3. Telephone 319 582-0363
4. Date of Incicent: 1/4/2001.
5. Time of Incident: 4:00 P.M.
6. Location of incident: 1596 Atlantic St.
7.
DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJurY OR DAMAGE.
(Give, full details uponz, which you baSeCyour claim~ If a City
employee was involved, give the employee~ s name. )
Raw sewage backed up through our sewer line from a blocked line in the
city street.
8. What were weather conditions like? 28 degrees, Cloudy
9. ~ive ~ame and address of any witnesses. ~(%}e-'-'-~c~cc~
10. Did police investigate? (If so, give names of officers.)
11.
Was anyone !n]ured. (If so, give D~me, address and extent of
injuries. )
12. Was any d~mag, e-done to property? (If so, describe property
and the extent of damage. Attach estimates of damages or
describe basis for ascertaining extent of d~mage,)
Yes - carpet & pad was damaged and will have to be replaced. Towels used for cleanup were destroyed.
13. ~at other d~ges 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
in.surancg~company and amount paid. )~
Yes, Damage was compensated in the amount of $1492.29 West Bend Mutual Ins. c/o Friedman Insurance.
15. What amount do you claim from the City of Dubuque? $250.00 - deductible not paid by Insurance company.
16. Why do you claim the City of D~u~e is responsible?
It was a blocked line in the City sewer line which caused our damage.
d
17.
Have.-youmade-any~-claim. agains%anyone else~for damages as
result of this incident? ~
If yes, give name and address=
a
18. If the answer to Question 17 is yes, have you received any
-" pa~ant:fr~' ................ ' ..... ·
that source, and if so, in what amount?
Dated at Dubuque,-Iowa, this 28th day of March, ,
2001
/s/ Joseph E. Dolan
~ (Signature)
ONE'
2ool
5855 Saratoga Road
Dubuque, towa 52002
(319)557-7212
587 University Ave.
Dubuque, Iowa 52001
(319)557-7213
Page No. J of. / Pages 3 9 8 8
FLOORING
PROPOSAL
· JOb PHONE NO.
JOBNAMEINO.
1. Removing plumbing fixtures, removing gas appliances or cutting
doors.
3. Conditions of existing moldings, doom, jambs or fixtures.
Additional Terms:
We Propose hereby to furnish material and labor - complete in accordance with above
(~.~_ specifications, for the.sum of:~.
Payment ~o be made as follows: 1/ / .~ /'/'
Acceptance of Proposal: The above prices, specifications and conditions are smisfactory and are hereby accepted. You are authorized to do the work
X... · as specified. Payment wiIl be made as ougined above.
950 Main St.
Dubuque, Iowa 52001
2001
319-556-6158
800-556-6158
F ~
ax: ~ 19-556-4680
January 31, 2001
Bill to:
Joe Dolan
1596 Atlantic
Dubuque, IA 52001
582-0363
I-4-01
Sewage Damage
INVOICE
· Remove towels saturated with sewage; bag up
· Extract sewage from carpet
· Extract sewage from shower and clean area
· Extract sewage from linoleum
· Apply deodorizer/disinfectant to all area
· Clean and disinfect equipment ~ shop
$150.00
1-5-01
Remove carpet affected by sewage
Apply deodorizer/disinfectant to cement
Dump Fee
TOTAL
~eer~ool~dr~ow~
$ 85.00
$ 50.00
VDO Professional Services/