Claim by Gary and Kerry Massey~, ,
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your Gaim against the City of Dubuque, Iowa. You should complete this form in full and
attach any additional information that supports your claim.
The Gaim must be filed with the City Clerk at City Hall, 50 West 13~' St., Dubuque, IA 52001. It will then be referred to
the appropriate department for investigation and to the City Attorney's Office. 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 Gaims 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: Gary & Kerry Massey2. Address: oZ g vZ~ w QSY1 I~'1~'fZ~~'1-,S"~_- ~_~qUe -~ cJa~J i!
3. Telephone Number: 5 $c~ - ~ g ~'~
4. Date of Incident: ~~'"~ ~ ~~O
5. Time of Incident: (C~-~ t~~-~J'~h /XJ 1'1~
6. Location of Incident (Be specific): ~S-PrYL~,~'L7 , ~ ~.~~o2g ~/~/Q~~'1 I Y~~.~
7. Describe the 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.)
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8. What were weather conditions like? (.t~ / N T ~ 2 _:_ - `D
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9. Give name and address of any witnesses: ~ 6 TO '- ~ da~G l~ ~ ~
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10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries.)
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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.)
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1/27/09
`TO WHOM IT MA's CONCERN"
7. -Our main sewer drain was clogged.
16. - We called Roto Rooter to unplug our sewer drain. First he put the snake down it,
then he put the balloon down it and he went 70 ft to the main line. We got some tampons
and baby wipes, but the drain was still clogged. He then instructed us to call the city to
jet the main sewer line. When the city came up they jetted the main line and the man
from Roto Rooter was in the basement at the opening of the drain when the city jetted
it he said he heard it right away let loose. We are in our 60's and have not used tampons
or baby wipes for quite some time. My husband (Gary) called John Klostermann and he
told him to fill out this form and explain the problem. We feel and so does the gentleman
from Roto Rooter that our main line was clogged that the city takes care of. We are
submitting a bill for the cost of the Roto-Rooter and would like reimbursed for the cost.
You may call us as 563-582-9846 if you have any questions.
We asked Mr. Klostermann if there was a way to determine if we are connected with any
other line. He said they have to worry about removing snow first then he can do a dye
test after the bad winter.
Thank you,
Gary & Kerry Massey
2828 Washington St.
Dubuque, Ia 52401
Locally Owned and Operated ~OrO~
HORKHEIMER PLUMBING, INC...,..R~O'TER®
D:B.A: ROTO-ROOTER : -
tEWEaI-GRAIN
SERVICE
" ~nd y~way Gjo Q2ou6les `Down ttie `basin "
P.O. Box 1533 • Dubuque, Iowa 52004 • Phone 563-552-1828
• TV Camera Inspection & Video Recording
• High Pressure Water Sewer Cleaning • Electric Sewer Cleaning
CUSTOMER'S ,
ORDER NO. DgTE ~~,- lit 20
NAM
ADDRESS
'P. , C
HERE'S THE PROBLEM I FOUND AND.FIXED.. CHARGES
,, '
YOURi, _ `.:> - ;.; WAS CLOGGED BY: sink .......................................$ •'
l7 sink. - ,0"grease tub.. K " $
^ tub ot'shower O food "~ ~ _ ............. .................. ~
O toiletpaper or sanitary products • toilet ...............................:`....$
^ laundry I washer lines ~ ^ hair
^ lint , ~~ ~ ~/ floor drain ..:.............:.............$ ~~.
^ floor drain
O septic lank Gne '` ^ tree roots ~ v/ ~, ~w laundry ... 'alts":.... ....$
~`matn sewer 6ne +~"`~ ^ foreign obleds
.bother ` ~ ~ ~ a l] sludge r~ ; ~ 7 ~~ septic line ...$
..$ ,~~~
_ s;,0'soap resB"ue main sewer
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C] other ~ '
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-TOTAL FOOTAGE•CLEANED• ~. .KNNESUSED~•~ ~ ,'~
JOB DESCRIPTION AND RFJNARKS.~ ~ ~~~ $
,. .. , .;.
~ f` 7~ TOTAL*~' '~~~, .1;;
COST MER GNA ,~ ~ OPERATOR SIGNATURE
PLEASE Y FROM THI INVOICE
A service charge of 1112X per month (18X per annum) will be charged to all accounts i~ ~+ _
30 days. Coats plus reasonable attorney fees to be added in case of suh for collection. \~(~ ~: .
~. 11
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STORE YOUR OUR~.ICATE CHECKS IN YOUR CHECK BOX. Q Q
1. (~`7r8CIC yOUr eXpEOSES... ^TAX-DEDUCTIBLE ITEM 8782
L7 Clothing ~ ^ Fo~ ~ p T~an~~orta~ on -
^tite' t ~hrd~ ' ~~ Milt s.- ` [] or ~! .~` (' 2
[L~ntertafr~nent ^ Insurance ^ Other: /° ~ ~~ .• Ut~
Y° ~~ ~ ~ 'BALANCE
~/ „~ FORWARD
/~ ~,-~ ~ ~ _'~~ THIS ITEM ' Y ° ,y
C ' _ ,f
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BALANCE
~ DEPOSIT
OTHER
~~ BALANCE
FOR~{JARD
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13. What other damages do you daim, if any? CJ' ~ 1 ~ ~(/ ~ ~`t..~ , ~~
14. Have you been compensated for any part or all of your daim by any insurance company? (If so, give name and
address of insurance company and amo1unt paid.)
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15. What amount do you daim from the City of Dubuque? ,~ y y~- ~~
16. Why do you daim the City of Dubuque is responsible? ~'~L ~ ~~~ h~
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17. Have you made any daim against anyone else for damages as a result of this inddent? (If yes, give name and
address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated this ll day of~2r~~d~'I , 20~.
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(Signatur
(Print Name)