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Claim Heinz, CatherineCLAIM 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: Catherine Heinz 2. Address: 2320 Clarke Crest Dr. 3. Telephone Number: 556 6034 4. Date of Incident: June 13, 2002 5. Time of Incident: 11:30 A.M. 6. Location of Incident (Be specific): Water was oozing from water meter and had already soaked my rug. 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.) I went downstairs to do some laundry and heard a unfamiliar sound. Upon investigating water was squirting in all directions. The floor was flooded which spread over one half of the carpeting in adjoining rooms. I called the water dept. and a new meter was required. I was informed to submit bills to the city for damages. 8. What were weather conditions like? Normal 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.) Yes, my carpet was water soaked in approx. 1/2 of my lower lev el. Books and papers were wet. 13. What other damages do you claim, if any? My claim is for water cleanup and a new carpet. 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.) No 15. What amount do you claim from the City of Dubuque? Clean up amt. $698.75 new rug installed = $3244.00 (lowest bid) 16. Why do you claim the City of Dubuque is responsible? The city owns the water meter and the rupture caused the damage. 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 25 day of July, 2002. /s / Catherine Heinz (Signature) (Print Name) (Rev. 1/00 & 7/01) 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: ~,z.,~'~ ../l.~ ~ 2. Address: .~ -~ ~ , ~ ~-" ~ ~ 3. Telephone Number: - c~ , o c~ ~ ~ 4. Dateoflncident: ~ P /~ / ~ ~ ~ ~ 5. Time of Incident: ~ /~ ~ 6. Location of Incident (Se specific): ~ ~ ~, ~J ~ ) 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) 11. 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.) 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 dayof ~ , 20 (Signature) (Print Name) (Rev. 1/00 & 7/01) 950 Main St. Dubuque, Iowa 52001 563-556-6t68 800-556-6168 Fax: 563-556-4680 July 23, 2002 Catherine Heinz 2320 Clarke Cre~ Dubuque, IA 52001 556-6034 Invoice: Water Damage 6/13/02 Extract water from glued down carpet Move furniture and block up Apply deodorizer Install drying equipment $ 218.75 Rental: (3) air movers ~ $30?day/each/4 days (1) dehumid/fier @ $30/day/4 days $ 360.00 $ 120.00 NOte: Price includes service calls. Tot~: $ 698.75 Thank you for calling KANNDO Professional Services! WHOLESALE FLOORING Mrs. Edward Heinz 2320 Clarke Crest Dr. Dubuque, IA 52001 TEL (319)583-9127 FAX(319) 588-1233 July 11, 2002 Re. Carpet replacement in lower level. We propose to furnish and install the following: Philadelphia Moon River:Hearthstone berber carpet. 15 x 65 = 108.33 sq yds. Carpenter Ensign 6 lb. rebond pad. Iowa sales tax on materials. Remove and dispose of existing rubber back carpet. Move and replace all furniture and fixtures. Complete installation of all materials in great room, bedroom and closet. $ 1721.00 $ 332.00 $ 123.00 $ 367.OO $ 87.oo 614.00 TOTAL 50% deposit due on order, balance on completion. Allow 2 weeks for order, delivery, and installation. Sincerely, Michael J. Kahle $ 3244.00 CARPET VINYL CERAMIC tfARDWOOD PLAZA"20" 2600 DODGE ST. · DUBUQUE, IA 52003 1475 Associates Drive - Dubuque, Iowa 52002 - Phone:(319) 557-9952 - Fax: (319) 557-9988 Catherine Heinz 2320 Clarke Crest Dr. Dubuque, Iowa 52001 563-556-6034 06-20-02 JOHN SEIER Fax Work Phone Date Salesperson carpet replacement for rec room bedroom _We propose: 1) Remove existing carpet in rec room and bedroom. The existing carpet is foam backed carpet. _ 2) Provide and install new carpet of a similar quality 996 sq ff $0.31 996 sq ff $2.63 $308.76 $2,619.48 3) Move fumiture _ 4) Provide and install new finishing metals taxes $175.00 9 ft $1.85 $16.65 propoes~ ~.o o2-2~-=oo0 TOTAL $187.19 $3,307.08 Floor Show Companies propose hereby to furnish material 8. labor complete in accordance W~h above specifications for the amount of: · ~cceptance of proposal. The above prices, specifications and conditions are satisifactory and are hereby accepted F~or Show Companies ~s authorized to do the work es specified. Acceptance must be signed. The proposal is void after 30 days. the right to withdraw the proposal at anytime, for any reason, Floor Show Companies reserves under any circumstance. Date of Acceptance / / Signature.