Claim, Judge, James E.CLAIM 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 additlonal infor~tion 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~.ndation.
THE FINAL DECISION ON ALL CLAIMS IS F~ADE BY THE CITY COUNCIL.
NO EMPLOYEE OF THE cITY OF DUBUQUE HAS TRE AUTHORITY TO MAKE ANY
REPRESENTATION TO YOU/kS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE
PAID.
1. Name of Claimant: James E. Judge
2. Address: 289 Southgate Dr., Dubuque, IA 52003
3. Telephone 563 583-4050
4. Date: 25 Feb. 01
5. 8 A.M.
6. Location of incident. (Be specific) Home
7. DESCRIBE ACCIDENT OR OCCURRENCE T~AT CAUSED INJURY OR DA/~AGE.
{Give full details upon w~ich you base your claim. If a City
employee was involved, give the employee's name.)
Sewer water backed up into our basement. Roto Rooter serviceman ran snake through
our line and found nothing. He then opened a manhole cover and discovered the city
sewer was backed up.
8. Weather: Clear
9. Witnessess: NA
10. Police Investigate: No
11. Injury: No.
· 12.
Was any damage 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.)
Sewer water ran over approximately one half of the basement floor, causing the tile
flooring and the carpet to become saturated. Service Master of the Key City cleaned,
sanitized and cut and removed carpet and padding.
13. Other damages: None at this time.
14. Compensated: No.
15. What amount do you claim from the ·City of Dubuque?
$1,777.50 total (Roto Rooter = $119 Service Master = $238.30 Floor Show $1420
16. Why do you claim the City of Dubuque is responsible?
Because sewer water from the city line backed into our basement and caused
damage.
17. Have you made any claim against anyone else for damages as
result of this incident? Our insurance Co. will not pay our claim because Sewer Water
backed into our home.
18.
Dated at Dubuque,Iowa, this 23 day of April, 2001.
/s/ James E. Judge
{Revised January, 2000)
m~n~ure~
(Print Name)
Locally Ck~ and {)per.ted ~ %f.~L
. . ...,..
P.O, Box 1533 · Dubuque, Iowa 520~. Phone 319-55fi-1828
· ~ Camera Insp~tion & V~ R~ording
· High P~e~um Se~ing Sewer Cleaning · El~t~ic Sewer Cl~ing
CUSTOMER'S
ORDER NO. DATE ~
H~S ~E PR~M I F~ND ~D FIXED.
YOUR: WAS ~ED BY:
~ s~k ~ gr~
~or~r ~f~
~ ~aet ~ ~r or san~ proau~s
~ ~U~ l~r ~s ~ hair
~.~r-dran Q ~m
~ ~k ~ ~ tree r~s
~~ ~p r~idue
~ other
mTALF~TAGECLE~ED' ,/~ ~_ KNIVESUSm '~_
JOB DESCRI~ION AND RE~S:
A ~ce ~ar~e of 1 1/2% per mq~h (18% ~r a~) will ~ c~rgea to all a~unts
~da~ C~tF~S rea~na~a~o~y~ o ~ add~ n c~e o s~f~r ~lec~om
CHARGES
toilet .................................... $
floor drain ........................... $
laundry ...............................
septic line ............................ $_
$
$
TOTAL
Servic aster of the Key City
1845 Washington St.
Dubuque, IA 52001
Invoice
DATE INVOICE #
2/27701 1111287
BILL TO
Jim Judge
289 Southgate
Dubuque, IA 52001
TERMS SERVICE DATE
i
DESCRIPTION QTY RATE AMOUNT
Emergency Service Call/Water Damage: Clean, sanitize floor, cut 3 75.00 225.00T
and remove carpet and padding
Dubuque Local and State Sales Tax 6.00% 13.50
///
(I ) Thank you for choosing ServiceMaster of the Key City! Have a great day!
Total
FLOO~'SHOW COMPANIES
1475 Associates Drive
Dubuque, Iowa 52002
(319) 557-9952
PAYMENT RECEIPT
Customer's Name:
Payment Date:
Payment Amount:
Payment Method:
Cbeck #.
redit Card
Cash
Invoice(s) Payment Applies to:
Salesperson Shown on Invoice(s):
Payment Received by:
Comments: