Claim - Welu, Nancy L.CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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 W. 13th St., Dubuque, IA 52001. 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 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.
1. Name of Claimant: Nancy L. Welu
2. Address: 95 S. Algona
3. Telephone Number: 563 556 3975
4. Date of Incident: 8/20/01 & henceforth
5. Time of Incident: No sure
6. Location of Incident (Be specific): My home has received cracks in its plaster due to the blasting, jackhammering on the street -
Living room.
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. If a City employee was involved, give the employee's name.)
Horsefield Construction was tearing up Algona Street and doing lots of banging, jackhammering etc. I noticed on 8/21/01 that my living room was had cracks in the plaster.
I have since had more cracks in the plaster in the living room.
8. What were weather conditions like? Sunny
9. Give name and address of any witnesses: None
10. Did police investigate? (If so, give names of officers.) No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of damages or describe basis for ascertaining extent of damage.)
The damage has been done to the walls in my living room. I don't know how to estimate the cost of the damage as the S wall seems to have shifted and just plastering over it would not fix it.
13. What other damages 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 insurance company and amount paid.)
I have noticed more cracks since the initial crack on August 20, 2001, obviously my home has shifted due to this construction on the street.
No.
15. What amount do you claim from the City of Dubuque?
I'm not sure.
16. Why do you claim the City of Dubuque is responsible?
Because it is the City of Dubuque who is rebuilding the street.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 8th day of October , 2001.
/s/ Nancy L. Welu
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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 W. 13~ St., Dubuque, IA 52001.
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 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 ?l~,L OR WILL NOT BE PAID.
lil Name of Claimant:
2[ Address:
T
elephone Number: ~- ~ -~
Date of Incident:
/
5~ Time of Incident:
6:/ Location of Incident (Se specific):
~hat w~m w~her ~n~iti~n~
9. Give name and address of any witnesses:
lq. Did police investigate? (If so, give names of officers.)
1t. Was anyone injured? (If so, give names, addresses, and extent of injuries).
12. Was any damage done to property? (If so, describe property and the extent of damages.
Attach estimates of damages or describe basis for ascertaining extent of damage.)
13. What other damages 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 insurance company and amount paid.)
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
17. Have you made any claim against anyone else for damages 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, in what amount?
Dated at Dubuque, Iowa this ~ ~ day of
(Rev. 1/00 & 7/01)
~ignature)
~/Print Name)