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Claim by Jennifer Connolly Copyrig hted February 15, 2021 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: Jennifer Connolly for property damage; Dennis Day for property damage;Ashley Johnson for property damage; Biniv Maskay for personal/property damage. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Claim by Jennifer Connolly Supporting Documentation Claim by Dennis Day Supporting Documentation Claim by Ashley Johnson Supporting Documentation Claim by Biniv Maskay Supporting Documentation Provrding lnsuran�c��r�d Finar�craJ Ssrvl��s �ry �+ � �!?!�`!�Q�fICL', �1'�7C3Y''Y'�'??!J]C,��'Olt,1� ��i�R�� January 25, 2021 i City Of Dubuque Subrogation Services � 50 W �3th St PO Box 106173 Dubuque IA 52001-4805 Atlanta GA 30348-6173 ` ; ; I . � ',� RE: �laim Number: �5-15D4-64Q � Our Insured: Mich�ei or Jennifer Connolly �� Date of Loss: January 2, 2021 Your Insured: City Of Dubuque Loss Locatian: 795 Lowell St, Dubuque, IA �'',� To City Clerk: Facts of Loss: Water Main Break And The Water Enter The Basement Of The Hame. � It is our understanding that you are self-insured. Our investigation indicates you are responsible for this claim. Therefore, we are seeking recovery from you. This letter is to notify you of our � subrogation claim and request your cooperation in settling this matter. To assist you in your review, here is a breakdown of the arnounts State Farm° paid by Cause of Loss: Building/Structure $6,101.36 Contents/Personal Prope�ty $0.00 Additional Living Expenses $0.00 Other $0.00 Amount State Farm Paid $6,101.36 Insured Deductible $1,000.00 Total Claim Amourtt $7,101.36 Based on the assessment of liability between the parties, Sta#e Farm Fire and Gasualfiy Company is seeking 100% of the Total Claim Amount listed above. The amount payable to State Farm Fire and Casualty Company for this loss is $7,101.36. Please remit payment of this claim and include our claim number on the payment. If you have any questions or need additional information, please call me at the number listed below. If I am not available, any other member of my team may assist you, Thank you for your cooperation. In order to assist you in evaluating and processing the subrogation claim we are asserting, we may provide nonpublic personal information about our customer. We are sharing this 15-15D4-64Q Page 2 January 25, 2021 information to effect, administer, or enforce a transaction authorized by the consumer. Hawever, you are neither authorized nor permitted to: (1) use the customer information we provided for any purpose other than to evaluate and process the subrogatian claim, or (2) disclose or share the customer information we provide for any purpase other than to evaluate and prc�cess the � subrogation claim. Sincerely, � Tammy Jackson Claim Associate (877) 787-8276 Ext. �Oa944$040 Fax: (866) 847-0049 statefarmfireclaims c�statefarm.com State Farm Fire and Casualty Company Enclosure: **ENCLOSURE** � � � �� , � �-�=� �� k.� 1 t,j � � � � � � .��'�.� � �� Email: PROPOSAL � ��O�Q ' ��pTING & COOt�N Job Name; � 798 Cedar Cross Rd. Dubuque,[A 52003 Location: Phone:(563)582-8884 Pax:(563)582-6563 www.allseasonshacom County: To: JENNIFER CONNOLLY 795 LOWELL ST. DUBUQUE, IA 52001 Phone: Date -DEAN- 563-580-0678 1/4/21 We hereby submit specifications and estimates for: * Removal of old equipment. * Wiring of furnace. * New setback thermostat and 24V wiring. * Vent off furnace to vent outside of house. * A 16x25 external filter rack installed. * The supply &return duct to be reworked. * Rework gas line to furnace shut off included. * Condensate of units to floor drain. * All holes cut by heating contractor. * Taxes, installation,materials, &permits as applicable. Lennox-EL296E 96% EFF 70,000 BTU $ 3,200.00 Purchase Price to All Seasons Heating and Cooling * Lennox Warranty: l0 years parts and 5 years labor. Lifetime heat exchanger. 5 years stat. OPTION: Add $ 1,450.00 to install 50 gallon A.O. Smith hot water heater. * A.O. Smith Warranty: 6 years tank and parts. ALL_SEASONS HEATWG&COOLINU,INC.TERMS&CONDI'I'IONS: We propose hereby to fumish mateiials and labor—comp]ete in accordance with these specifications.All material is guaranteed to be as specified.Al]work to be completed in a workmanship like manner according to standard practices.Any alterations or deviation fiom above specifications iuvolving exCra costs will be executed only upon wntten orders�nd will become an extra cl�arge over and above the estimate.All agreements are contingent upon accidents or delays beyond our control. Owner is to carry fire,tornado,and odier necessary insurance.Our workers are fully covered by Workmen Compensation insurance. * Proposal prices are good for 30 days. * 50% down payment of purchase price due at time of acceptance. x Proposal must be initialed and signed by customer. � Authorized Signature �QiQ� (>/Qi(aQi��(�/ NOTICE TO CUSTOMER: Upon acceptance ofproposal—The prices,specifications and conditions are satisfactory and are hereby accepted.All Seasons is authorized to do the work as specified. �Progressive billings as work is completed.Balance due upon completion. *Any unpaid balance 10 days beyond invoicing date is subject Yo 1.5%service charge per month. �Warranty applies to origina]biryer. Signature Date SERVPRO of Dubuque Servpro of Dubuque 8426 10479 Timothy street Ph. 563-584-2242 Fax. 563-584-2373 servpro8426@yousq.net Tax# 42-1474519 1/18/2021 8:39 AM Insured: JENNIFER CONNOLLY Estimate: JENNIFER CON1 Property: 795 LOWELL ST Claim Number: 1515D464Q DUBUQUE,IA 52001-3261 Policy Number: 15B9Q8549 Home: 563-580-0678 Price List: IADU28 JAN21 Type of Loss: Water Damage Restoration/Service/Remodel Deductible: $0.00 Date of Loss: 1/2/2021 Date Inspected: 1/4/2021 Summary for Dwelling Line Item Total 3,160.31 Material Sales Tax 3.42 Replacement Cost Value 3,163.73 Less Deductible (0.00) Net Payment $3 163.73 > dnky Terry Lenstra ALL AMOUNTS PAYABLE ARE SUBJECT TO THE TERMS, CONDITIONS AND LIMITS OF YOUR POLICY. SERVPRO of Dubuque JENNIFER CONNOLLY 1/18/2021 8:39 AM Recap of Taxes,Overhead and Profit GC Overhead(0%) GC Profit(0%) Material Sales Tax(7%) Manuf.Home Tax(5%) Line Items 0.00 0.00 3.42 0.00 Total 0.00 0.00 3.42 0.00 JENNIFER CONI Page: 2 3 Claim Number: Date: CONTRACTOR AND MATERIALS SUPPLIER WARRANTIES UNDER STATE FARM PREMIER SERVICEO Under the State Far�n Premier ServiceOO program (SFPSP), the State Farm policyholder is provided by the Contractor identified below,with the following warranties on repairs and materials for covered damage to a dwelling insured under State Fann's insurance policy: The Contractor identified on this estimate warrants for a period of five (5) years from the date of the policyholder's Authorization To Pay, that all worlcinanship of the Contractor and the subcontractors working on the repairs under the above Claim Number(1) will be performed in accordance with the Contractor's estimate, the agreement between State Farm and the Contractor for Premier Service Program, and any construction agreement with the policyholder, and (2) will be of good quality and free froin any fault or defect. The Contractor agrees to resolve and correct any warranty issue within ninety (90) days of the receipt of the written notification to Contractor of the warranty issue. The Contractor further agrees that it will reimburse the policyholder for the dollar value cost of the building repair for any warranty issue not corrected by Contractor within the ninety (90) day period. The Contractor agrees that this warranty will inure to the benefit of State Farm, the policyholder, and their successors or assigns. This warranty excludes damage caused by normal wear and tear, improper maintenance, and/or abuse. The Contractor also warrants for a period of one year from the date of the policyholder's Authorization To Pay, that all materials, equipment, or other building components furnished by the Contractor or its subcontractors in the above repairs will be new, of good quality, and free of defects and will inure to the benefit of State Farm, the policyholder, and their successors or assigns. This warranty is limited to visible defects for materials and equipment furnished in connection with the above SFPSP repairs to the Contractor by any SFPSP service provider or any non-SFPSP provider of the materials used in connection with the repair worlc. Should the Contractor discover any governmental building code violations to the property that may void the material manufacturer's warranty or its own workmanship repair warranty, it will immediately notify the policyholder and State Fann and give the policyholder the opportunity to take the necessary steps to correct the building code violation to ensure that all warranties will be in effect. If the policyholder refuses to take the necessaiy corrective action to ensure the application of all warranties, the Contractor agrees to notify State Farm immediately for the appropriate action to be taken in regards to this warranty issue. Insured Name: Repair Property Address: Contractor Name: Contractor Signature: Phone Number: SERVPRO of Dubuque JENNIFER CONNOLLY 1/18/2021 8:39 AM JENNIFER CONl Main Level Basement Height: 7' �--aa s��-� 40� � 784.00 SF Walls 640.00 SF Ceiling B,se,,,�n� - " 1,424.00 SF Walls&Ceiling 640.00 SF Floor � 112.00 LF Ceil. Perimeter 112.00 LF Floor Perimeter CAT SEL DESCRIPTION VAR/QUAN QUAN UNIT RESET REMOVE REPLACE TOTAL l9.DMO DTRLR - Tandem axle dump trailer-per load-induding dump fees 1 1.00 EA 203.60 203.60 damaged contents 11.WTR MUCK+ - Muck-out/Flood loss cleanup-Heavy F 640.00 SF 3.61 2,310.40 13.CLN F-+ + Clean floor-Heavy F 640.00 SF 0.52 332.80 Hot water wash floor l5.WTR EQDH + Equipment decontamination charge-HVY,per piece of equip 1 1.00 EA 45.82 45.82 water extractor truck l6.WTR EQD + Equipment decontamination charge-per piece of equipment 3 3.00EA 28.75 86.25 two hoses and a hard floor wand 20.WTR GRM + Apply anti-microbial agent to the floor F 640.00 SF 0.21 134.40 floor 21.WTR GRM + Apply anti-microbial agent to more than the floor perimeter PF*2 224.00SF 0.21 47.04 wal ls Totals: Basement 3,160.31 Totals: Main Level 784.00 SF Walls 640.00 SF Ceiling 1,424.00 SF Walls and Ceiling 640.00 SF Floor 677.78 Total Area 112.00 LF Floor Perimeter 640.00 Floor Area 114.67 Exterior Perimeter of 112.00 LF Ceil. Perimeter 917.33 Exterior Waii Area Walls 784.00 Interior WaII Area Total: Main Level 3,160.31 JENNIFER COM Page: 4 SERVPRO of Dubuque JENNIFER CONNOLLY 1/18/2021 8:39 AM Line Item Totals: JENNIFER CON1 3,160.31 Grand Total Areas: 784.00 SF Walls 640.00 SF Ceiling 1,424.00 SF Walls and Ceiling 640.00 SF Floor 71.ll SY Flooring 112.00 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall l]2.00 LF Ceil. Perimeter 640.00 Floor Area 677.78 Total Area 784.00 Interior Wall Area 917.33 Exterior Wall Area 114.67 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length JENNIFER CON 1 Page: 5 RBZ0003U StateFarm State Farm Fire and Casualty Company ��@ Fire Payments Route To:Tammy Jackson BASIC CLAIM INFORMATION Claim Number: 15-15D4-64Q Date of Loss: 01-02-2021 Policy Number: 15-B9-Q854-9 Named Insured: CONNOLLY,JENNIFER PAYMENTS C denotes consolidated payment E denotes EFT payment Pavment Number Issued Date Pavee Status Amount Auth ID EFT PYMT E SERVPRO Non Processed $3,163.73 GZTH 106440186J 01-15-2021 JENNIFER CONNOLLY&MICHAEL Outstanding $3,770.38 GZTH ROBERT CONNOLLY Grand Total: $6,934.11 Date: 01-25-2021 Page 1 STATE FARM CONFIDENTIAL INFORMATION Distribution on a Business Need to Know Basis Only :� ' � . .�'�f ,t� v�1f� R }",cy�,�s �S�z �?� �r �' '. y�,� f � �;�a `�tn� M-� � � ��j�i�.��'� � r . � � ,�`�('�"a'' �$`��`��'�,,�,� .. s�'� �H`� S,r��jyp��f,eF�`��,"�5°`� r,+� Cd^� � 2'r- r '�R��.q�a �a .� � � a�,� '� S !: Y � a,�.��'�', .�`� �'��:�� . i usa^l�k�� 'r t i � '�A.,n, � . �v. r� r��, 't �-?na � � . ��4�� :k.�'^*]*a�'�'r � �8��' r�� 9 a�u��k ' �d'� .� . ] �� w -:. : �,. `� �'�� `34 n � � t . � .-' - : ,, �t � '��s „ s�� s y �.z fs�K�� ` } � ��'��' `` L'� � �,��r� «��, �t_ r.�;, �- � �'� � � �' c n �n��'�'t��f � t ,x�> �` � ��"�'�,y -kas�s � 5+ ��p � �' . � .� � as^,�,' '^ y. , �'��7 ��"'��,z'P�,7� . �d�' ... ,v,� � �' � . . �f��s �� z . -..��+ "Y,_� . . h � �,v � � � �r � ,u,�," . . r,��s'4'.�". 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