Claim, Miller, BillCLAIM AGAINST THE CITY OF
DUBUQUE
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 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 reporu 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.
Name of Claimant: Bill Meyer
Address: 1464 Central Ave.
3. Telephone Number: 651-644-4336
4. Date of Incident: FEB 26-01
5. Time of Incident: Afternoon
6. Location of incident. 1464 Central, Basement & 1st Floor,
7. Describe accident: Water / Sewer Plugged up causing Water Damage & Cleanup in my building.
City sewer was involved & worked on the main line.
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INouRY OR DAMAGE.
(Give full detai~ls upon% which you base your claim, if a City
employee was involved, give the_employee's name.)
8. ~at were weather conditions like?
9. Give n=e a~d address of any witnesses.
10. Did police investigate? (If so, give n~es of officers.)
11.
Was anyone injured? (If so, give name, address and extent of
injuries. )
12.
Was any damage done to property? (If. so, describe proper=y
and the extent of damage. Attach estimates of damages or
describe basis for ascertaining extent of da/nage.)
13. What other d~ages do you claim, if any?
14. Have you peen compensated for any part or all of your claim by
any instance company? ~ (If so, give n~me and address of
insurance company and ~o~t paid.)
15. What amount do you claim from }he City~ of Dubuque?
$167.00
16. Why do you claim the City of Dubuque is responsible?
Main SEwer was plugged - City Crew Spent 2 Hrs. working on site. Rotor Rooter said
sewer line was plugged at main line.
17. Have you made ~y' cta~ against ~yone else for d~ages 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, ~n what amoLult?
Dated this 30th day of March, 2001.
/s/ Willliam Miller
(Revised January, 2000)