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Claim by State Farm a/s/o Michael or Jennifer Connolly Copyrig hted March 1, 2021 City of Dubuque Consent Items # 2. City Council Meeting ITEM TITLE: Notice of Claims and Suits SUM MARY: 2G2, LLC. for breach of lease;Asbury Square LLC for property damage; Jackie Jones for property damage; additional claim information from Ronald Koehler for property damage;Aaron Rang for vehicle damage; Jacob Schlosser for property damage; additional claim information from State Farm a/s/o Michael or Jennifer Connolly for property damage. SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney DISPOSITION: ATTACHMENTS: Description Type Claim by 2G2, LLC Supporting Documentation Claim by Asbury Square LLC Supporting Documentation Claim by Jackie Jones Supporting Documentation Additional Claim Information by Ronald Koehler Supporting Documentation Claim by Aaron Rang Supporting Documentation Claim by Jacob Schlosser Supporting Documentation Additional Claim Information by State Farm a/s/o Supporting Documentation Michael or Jennifer Connolly Provrding lnsurance and Financial Services c�StateFar Home Office, 8loomington, 1L January 25, 2021 City Of Dubuque Subrogation Services 50 W 13th St PO Box 106173 Dubuque IA 52001-4805 Atianta GA 30348-6173 RE: Claim Number: 15-�5D4-64Q Our Insured: Michael or Jennifer Connolly Date of Loss: January 2, 2021 Your Insured: City Of Dubuque Loss Location: 795 Lowell St, Dubuque, IA To City Clerk: Facts of Loss: Water Main Break And The Water Enter The Basement Of The Home. 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 amounts State Farm° paid by Cause of Loss: Building/Structure $6,101.36 Contents/Personal Property $0.00 Additional Living Expenses $0.00 Other $0.00 Amount State Farm Paid $6,101.36 Insured Deductible $1,000.00 Total Claim Amount $7,101.36 Based on the assessment of liability between the parties, State Farm Fire and Casualty 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. However, you are neither authorized nor permitted to: (1) use the customer information we provided for any purpose other than to evaluate and process the subrogation claim, or (2) disclose or share the customer information we provide for any purpose other than to evaluate and process the subrogation claim. Sincerely, Tammy Jackson Claim Associate (877) 787-8276 Ext. 205944$040 Fax: (866) 847-0049 statefarmfireclaims@statefarm.com State Farm Fire and Casualty Company Enclosure: **ENCLOSURE*� RBZ0003U SfateFarm 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 106446295K E 01-25-2021 SERVPRO Paid $3,163.73 GZTH 106440186J 01-15-2021 JENNIFER CONNOLLY&MICHAEL Paid $3,770.38 GZTH ROBERT CONNOLLY Grand Total: $6,934.11 Date: 02-10-2021 Page 1 STATE FARM CONFIDENTIAL INFORMATION Distribution on a Business Need to Know Basis Oniy 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 CONI Property: 795 LOWELL ST Claim Number: I S 15D464Q 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: 1l2/2021 Date Inspected: 1/4/2021 Summary for Dwelling Line Item Total 3,160.31 Materiai 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 CON 1 Page:2 3 Claim Number: Date: CONTRACTOR AND MATERIALS SUPPLIER WARRANTIES UNDER STATE FARM PREMIER SERVICEO Under the State Farm Premier ServiceOO program (SFPSP), the State Fa1-m 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 Farm's insurance policy: The Contractor identified on this estimate warrants for a period of five (5)years froin the date of the policyholder's Authorization To Pay, that all workmanship of the Contractor and the subcontractors working on the repairs under the above Claiin Number (1) will be performed in accordance with the Contractor's estimate, the agreement between State Farm and the Contractor for Premier Service Prograin,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 wananty 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 dainage caused by nonnal wear and tear, improper inaintenance, 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 work. Should the Contractor discover any governmental building code violations to the property that may void the inaterial 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 wai�anties will be in effect. If the policyholder refuses to talce the necessary corrective action to ensure the application of all warranties, the Contractor agrees to notify State Fann immediately for the appropriate action to be talcen 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 CONI Main Level Basement Height:7' �--aa s��-� .-40 � 784.00 SF Walls 640.00 SF Ceiling 8,5�,,,��, - - 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 19.DMO DTRLR - Tandem axle dump trailer-per load-including 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 16.WTR EQD + Equipment decontamination charge-per piece of equipment 3 3.00 EA 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*2 224.00 SF 0.21 47.04 walls 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 l 12.00 LF Ceil.Perimeter 917.33 Exterior Wall Area Walls 784.00 Interior Wall Area Total: Main Level 3,160.31 JENNIFER CON1 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 71.11 SY Flooring 112.00 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 112.00 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 CON1 Page: 5 Email: PROPOSAL � ��Q ' N�p►TING &COO��N Job Name: G 798 Cedar Cross Rd. Dubuque,[A 52003 Location: Phone:(563)582-8884 Fax:(563)582-6563 www.allseasoi�shc.com 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°/a EFF 70,000 BTU $ 3,200.00 Purchase Price to All Seasons Heating and Cooling * Lennox Warranty: 10 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 HEAT[NG&COOLING,INC.TERMS&CONDITION5: We propose hereby to funusl�materia]s and labor—complete in accordance with these specifications.Al]material is guaranteed to be as specified.All work to be completed iu a wodcmansliip like manner according to stat�dard practices.Any alterations or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate.All agreemencs are contingent upon accidents or delays beyond our control. Owner is to carry fire,ton�ado,and other necessary insurance.Our�vorkers are fiilly covered by Workmen Compensation insurance. * Proposal prices are good for 30 days. * 50% down payment of purchase price due at time of acceptance. * Proposal must be initialed and signed by customer. � �, Authorized Signature �QiQ� (,/�i�i�(,{/��i NOTICE TO CUSTOMER: Upon acceptance of proposal—The pnces,specificatious 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 beyo��d invoicing date is subject to 1.5%service charge per month. *Warranty applies to origina]buyer. 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The Claim must be filed �nrith the City Clerk a# Ci#y H�II, 50 W. 13th S#., Dubuque, IA 52001. It will then be referred by the City Counci! ta fihe appropria#e department for investigatian. OnCe that investig�tion is cornpleted, a report and recammendation wilt be submitted to the Gity Council. You wil) be provided with a copy of that r�port and recomm�ndation. THE FlNAL DECISION OI� ALL CLAIMS IS IVIADE BY THE CITY COUNCIL. NC7 EMPLOYEE �F TNE GITY OF DUB!lQUE HAS THE AUTHORlTY TO MAKE ANY REPRESENTATION T� YOU AS TO WHETHER YOUR CLAIM WILL QR WILL NQT BE PAID. 1. Name of Claimant: �?�,,[� . ��m l�C,.��D t�t .�7 a� AA/ �.�t�.,� �no�,�� - 1 �. y 2. Address. '7 9 ,�,---�t�nl P� ��T • 1�f �q(.(:�L- �• Z va �' � _ 3. Telephone N�mber:__ .� (I 3 ' ,5''�A - Of07� 4. Date of Inciden#:__p � 1�t,l ?,p�� 5. Time of lncident: 4�; 3 p � ,,v� . 6. Locati�n ofi Incident (Be specific): 7. DESCRIBE ACCIDENT QR �CCURREMCE THAT CAUSED INJiJRY (?R DAMAGE, (Give full details upon which you base your claim. If a City emp�oyee was involved, give the 4'CTl f0 @'B'S f1111'1@.� � � Ll_a (J,� ,�� L �.� � �,rrw,� ,r,�v ;�, , M S� �,��rn.t.n� ,r,re,� �!�.�,r.rr.. 8. What were weather conciitions lik�? 9. Give name and address of any witnesses: �,o�y�t r 10. Did fice investigate? (If so, give names of officers.) 11. Was anyone injured? (If su, give names, addresses, and extent of injuries}. I 12. Was any damage done to Rraperty? (If so, describe pro�erty and the extent of damages. Atfiach estimates of damages or describe ba�is for ascertaining extent of damage.) � �, 13. What other damages do you claim, if any7 14. Have you been compensated for any part or ail of your claim by any insurance company? (lf sa, give name and address of snsurance company and amount paid,) 0 /73 �� _�.�?�- 95�y-!�a�°U ��rr�.�1�� .�Qi.� �' I� /S"A �{ t�{CsZ.. �'7, (D l. 3� -�— 15. What amount do you c6aim fr+�m the City of Duh�que? � ?, l�f. ��v 16. Why do you claim the City of Dubuqus is respansible? `� � ��q r�bVV�. �r '�. W .�. ' 17. Have you made any claim against anyone else for damages as a result of this incidenfi? (If� , gi�e name and address.) 18. ff t�e arrswer to Question 17 is yes, have you received any payment from that source, and it so, in what amount? Dated at Dubuque, lowa this�,a day af�.G _ � 20� ature} -s�._��L�► !A J�n!C�I a.� o'V �,,.V�J-�ri �( (Pr�nt Namef � �.�- � � -�,/n/ J�c�'� �_, �.� W� r � -^f`�� ; � ��: � � f c, _' � `�„� �-1 �� :�j ' tn „~� i- ;p � 1� �_ �' " �-' (�J � Copyrig hted March 1, 2021 City of Dubuque Consent Items # 3. City Council Meeting ITEM TITLE: Disposition of Claims SUMMARY: CityAttorneyadvising thatthe following claims have been referred to Public Entity Risk Services of lowa, the agent forthe lowa Communities Assurance Pool:Asbury Square LLC for property damage;Ashlynn Johnson for property damage; Jackie Jones for property damage; Aaron Rang for vehicle damage; Jacob Schlosser for property damage; State Farm a/s/o Michael or Jennifer Connolly for property damage. SUGGESTED Suggested Disposition: Receive and File; Concur DISPOSITION: ATTACHMENTS: Description Type ICAP Referral Supporting Documentation THE CTTY OF DUB E MEMORANDUM MasterpTece on the Mississippi � ONI MEDINGER LEGAL ADMINISTRATIVE ASSISTANT To: Mayor Roy D. Buol and Members of the City Council DATE: February 23, 2021 RE: Claim Against the City of Dubuque by State Farm a/s/o Michael or Jennifer Connolly Claimant Date of Claim Date of Loss Nature of Claim State Farm a/s/o Michael or Jennifer Connolly 02/10/2021 01/02/2021 Property Damage This is a claim in which claimant alleges claimant's basement flooded due to water main break. This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager Denise Blakeley Ihrig, Water Department Manager State Farm a/s/o Michael or Jennifer Connolly OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944 TE�EPHONE (563)589-4113/Fax (563)583-1040/EMai� jmedinge@cityofdubuque.org