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Claim by Debra Heim 09_02_05THE CITY OF DUB E MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: February 21, 2009 RE: Claim Against the City of Dubuque by the Debra Heim Claimant Date of Claim Date of Loss Nature of Claim Debra Heim 02/18/09 02/05/09 Property Damage This is a claim in which claimant alleges that her house, yard and shed at 710 Peru Road sustained water damage due to a water main break on Brunswick Street. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. BAL:tIs cc: Michael C. Van Milligen, City Manager Bob Green, Water Department Manager Debra Heim OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL tsteckle@cityofdubuque.org ,~ ~~ ~' ~i . 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: ~'~.6r~ /~' ~/!'e/ ~ 2. Address: D 3. Telephone Number: ~ ~i_ ~' O ~ 7 ~ ~~ ~p p 1~` ~j ~ 3 4. Date of Incident: 5. Time of Incident: ~~~ /~ ~ ~'3 a - Lo A~ v~ ~~ 6. Location of Incident (Be specific): ~lJ) ,fie ~ V ~d}~ ~~L, (~ ~; ~ ~ ~ ~a Q n ~~ ~ ~.d s sl, e~, s c a • v ~~ ,~-~-s 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.) 1~ ~f e r rn +9~ ~ rti re,~ ac a N 8 ~ ~ ~ ~ w-~ c, ]c s -1•- ~v~4~'- ~ r C /EjN ~~ ~14~ Fo /~'Gti' 8. What were weather conditions like? r Q 9. Give name and address of any witnesses: ~~,r--~,l (' ~~~~ ~j„ ~. ~ 7/pge~,~ 12~, -O ~ Lei 10. Did police investigate? (If so, give names of officers.) L° ~ iC ~clh~4C~- Q/~F~cer 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.) `~~S ~ ~ ~ l~o c~~5 13. What other damages do you claim, if any? B~~ Pr ~ C~ ~Iq I^~ t )~ - 1~~ S ~~y e ~ 5m~ LL.. Cr4rnp Re~S~';~~r ~'~o r ~'~ov r ~'N ~Sl~cd Spe~-ke~2 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.) N'~ 15. What amount do you claim from the City of Dubuque? 16. Why do you claim the City of Dubuque is responsi C i-1-,~ w ~A -~ ~e. r iin ~ ~ r~ 8 r~ k 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) /V O 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 ~~e~tl~~~ 20~ Signature) ~-e ~ 1~ ~ ~ ~ 1 l~ (Print Name) (Rev. 1100 & 7/01) ~,~vCL©Sec~ C7 ~ ~~ ~ w ~-~ - ~ ~ ~ ~ c~> ~._~ `~ .~ _ ~ r ;...~ ~' `-~= ~ gym' ~~~ /f~~ ~ ~~-~y C~~ ~ vh Q ~; ~ ~ rv5-~- L ~~- y d ~- v g . ~ UL ~. ~ yr .~ ~, ~~ ~ N~ . fi -,. , S ~ e--~ -t~f r a~ ~ ~ a.~y m o r ~ ~tib- ~, ~ ~e ~ 5-~ h a~~9 a ~ ~ S~~ d~ `~ -~ h ~ 5 C L.A ' ''h S~ h A V~ P v i- ~ n1 ~Fa r ~~sY~ Yr o-~-a ~' c ~- c ~~ ~ ~' ©N ~ S h ~ ~ ~ 1• Bch h ~ ~ ~.~ ~ -~ e ~' -~ h -e. p, fie. ~ l~ 5 ~ ,~ ~ o ~- k ~ ~' ~ ~ +~~- 5 /~ ~ v E /~ o I ~'~k~ ~~ ~ ~,-~ ass shed '~ ~ ~.~~d ~~ d m~~,~ .~ ~L,S ~ ~ c~.o~c ~ ~LL-~-d, 1~ D mom. ~' ~ ~ ~'-'~ ~= a 121 ~~ 5 5 ed ~ c .~ ~L-ea. ~- c> ~. o ~ ~~ k -~ o w ~~1~ a a 1 ~ti2~ ~ y ~l ESTIMATE FOR: Heim, Deb 710 Peru Rd Dubuque, IA 52001 Fh: (563) 557-4476 PROJECT DESCRIPTION: ESTIMATE Estimate From ~, - ~ STORE # 3057 DUBQ PHONE: (563) 556-5222 5300 Dodge Street FAX: (563) 556-2743 Dubuque, IA 52003 ESTIMATE BY ESTIMATE DATE KS 02/15/09 SKU NUMBER DESCRIPTION QTY TO ORDER 451-3432 GAS DRY,6.SCF,SC,3T,WHT RGD4400VQ 1 EACH FOR WHIRLPOOL WARRANTY ISSUES / CONCERNS OR CLAIMS CALL 800-253-1301 OR ONLINE AT WWW.WHIRLPOOL.COM *** If purchased today, you save $12.98 *** Estimate # 87832 Page 1 of 1 ADDITIONAL ITEM INFORMATION ON SALE THRU 02/15/09 This is an estimate. It is given only for general price information. This is not an offer and there can be no legally binding contract , between the parties based upon this estimate. The prices stated herein are subject to change depending upon the market conditions. TODAY SSUB-TOTAL: 3 87.00 The prices stated on this estimate are not firm for any time period unless specifically written otherwise on this form. The availability REGULAR SUB-TOTAL: 3 9 9.9 e of materials is subject to inventory conditions. MENARDS IS NOT RESPONSIBLE FOR ANY LOSS INCURRED BY THE GUEST WHO RELIES ON PRICES SET FORTH HEREIN OR ON THE AVAILABILITY OF ANY OF THE MATERIALS STATED HEREIN. All information on this form, other than price, has been provided by guest and Menards is not responsible for any errors in the information on this estimate, including but not limited to quantity, dimension and quality. Please examine this estimate GUEST COPY carefully. MENARDS MAKES NO REPRESENTATIONS, ORAL, WRITTEN OR OTHERWISE THAT THE MATERIALS LISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUEST. BECAUSE OF WIDE VARIATIONS IN CODES, THERE ARE NO REPRESENTATIONS THAT THE MATERIALS LISTED HEREIN MEET PAGE 1 OF 1 YOUR CODE REQUIREMENTS. Estimate From ESTIMATE FOR: Heim, Deb 710 Peru Rd Dubuque, IA 52001 Ph: (563) 557-4476 PROJECT DESCRIPTION: ESTIMATE STORE # 3057 DUBQ PHONE: (563) 556-5222 5300 Dodge Street FAX: (563) 556-2743 Dubuque, IA 52003 ESTIMATE BY ESTIMATE DATE gg 02/15/09 SKU NUMBER DESCRIPTION QTY TO ORDER 453-6296 REFRIG,I.7CF,COMPACT,WHT HNSB02 (NR) 1 EACH FOR HAIER WARRANTY ISSUES / CONCERNS OR CLAIMS CALL 877-337-3639 OR ONLINE AT WWW.HAIERAMERICA.COM Estimate # 87831 Page 1 of 1 ADDITIONAL ITEM INFORMATION This is an estimate. It is given only for general price information. This is not an offer and there can be no legally binding contract , TODAY S SIIB-TOTAL" 74.9 9 between the parties based upon this estimate. The prices stated herein are subject to change depending upon the market conditions. 97 REGULAR SUB-TOTAL: 7 9 The prices stated on this estimate are not firm for any time period unless specifically written otherwise on this form. The availability . of materials is subject to inventory conditions. MENARDS IS NOT RESPONSIBLE FOR ANY LOSS INCURRED BY THE GUEST WHO RELIES ON PRICES SET FORTH HEREIN OR ON THE AVAILABILITY OF ANY OF THE MATERIALS STATED HEREIN. All information on this form, other than price, has been provided by guest and Menards is not responsible for any errors in the information on this estimate, including but not limited to quantity, dimension and quality. Please examine this estimate C+TOn L~ /'~OP~7 ~7 1 l~L 1. I carefully. MENARDS MAKES NO REPRESENTATIONS, ORAL, WRITTEN OR OTHERWISE THAT THE MATERIALS LISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUEST. BECAUSE OF WIDE VARIATIONS IN CODES, THERE ARE NO REPRESENTATIONS THAT THE MATERIALS LISTED HEREIN MEET PAGE 1 OF 1 YOUR CODE REQUIREMENTS. Estimate From ~. ! ESTIMATE FOR: Heim, Deb 710 Peru Rd Dubuque, IA 52001 Ph: (563) 557-4476 PROJECT DESCRIPTION: insurence claim SKU NUMBER DESCRIPTION 261-9650 2/10/55 AMP CHARGER STORE # 3057 DUBQ PHONE: (563) 556-5222 5300 Dodge Street FAX: (563) 556-2743 Dubuque, IA 52003 Estimate # 87819 Page 1 of 1 ESTIMATE BY ESTIMATE DATE Alex 02/15/09 TO ORDER ADDITIONAL ITEM INFORMATION PKCOCG 1 EACH This is an estimate. It is given only for general price information. This is not an offer and there can be no legally binding contract ']'TAY'S SUB-TOTAL: 5 9.98 between the parties based upon this estimate. The prices stated herein are subject to change depending upon the market conditions. The prices stated on this estimate are not firm for any time period unless specifically written otherwise on this form. The availability of materials is subject to inventory conditions. MENARDS IS NOT RESPONSIBLE FOR ANY LOSS INCURRED BY THE GUEST \VHO RELIES ON PRICES SET FORTH HEREIN OR ON THE AVAILABILITY OF ANY OF THE MATERIALS STATED HEREIN. All infornration on this form, other than price, has been provided by guest and Menards is not responsible for any errors in fire infomtation on this estimate, including but not limited to quauti[y, dimension and quality. Please examine this estimate GUEST COPY carefully. MENARDS MAKES NO REPRESENTATIONS, ORAL, WRITTEN OR OTHERWISE THAT THE MATERIALS LISTED ARE SUITABLE FOR ANY PURPOFSE BEING CONSIDERED BY THE GUEST. BECAUSE OF WIDE VARIATIONS IN CODES, THERE ARE NO REPRESENTATIONS THAT THE MATERIALS LISTED HEREIN MEET PAGE 1 OF 1 YOUR CODE REQUIREMENTS. Estimate From ~' ! ESTIMATE FOR: Heim, Deb 710 Peru Rd Dubuque, IA 52001 Ph: (563) 557-4476 PROJECT DESCRIPTION: Insurance Estimate SKU NUMBER DESCRIPTION STORE # 3057 DUBQ PHONE: (563) 556-5222 5300 Dodge Street FAX: (563.) 556-2743 Dubuque, IA 52003 240-1102 PULSE 1850 GENERATOR PM0401857 ESTIMATE BY ESTIMATE DATE BC 02/15/09 OTY TO ORDER 1 EACH *** Zf purchased today, you save $29.97 *** Estimate # 87817 Page 1 of 1 ADDITIONAL ITEM INFORMATION This is an estimate. It is given only for general price information. This is not an offer and there can be no legally binding contract TODAY'S SUB-TOTAL: 369.00 between the parties based upon this estimate. The prices stated herein are subject to change depending upon the market conditions. REGULAR SUB-TOTAL: 3 9 a . 97 The prices stated on this estimate are not firm for any time period unless specifically written otherwise on this form. The availability of materials is subject to inventory conditions. MENARDS IS NOT RESPONSIBLE FOR ANY LOSS INCURRED BY THE GUEST WHO RELIES ON PRICES SET FORTH HEREIN OR ON THE AVAILABILITY OF ANY OF THE MATERIALS STATED HEREIN. All information on this form, other than price, has been provided by guest and Menards is not responsible for any errors iu the information on this estimate, including but not limited to quantity, dimension and quality. Please examine this estimate STORE COPY carefully. MENARDS MAKES NO REPRESENTATIONS, ORAL, WRITTEN OR OTHERWISE THAT THE MATERIALS LISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUEST. BECA~ISE OF WIDE VARIATIONS IN CODES, THERE ARE NO REPRESENTATIONS THAT THE MATERIALS LISTED H EREIN MEET PAGE 1 OF 1 YOUR CODE REQUIREMENTS. ~ PICKING LIST -GUEST COPY s~roRE ~f ~os~ DUBQ PHONE: ts~~~> ss~~-szzz CAS~IIER'- PRESS RECALL TRANS DUBQ 87829 spot) Doake street FAx: (st~~) ss~,-2743 AND SCAN BARCODE -_> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dubuque, IA sz003 CASHIER: PAGE 1 OF 1 I GUEST NAME -ADDRESS -PHONE I PL~:ASE STAPLE RF.(:EIPT HERE. SOLD BY: BRANDON DATE: 02/15/09 Heim, Deb 710 Peru Rd Dubuque, IA 52001 Ph: (563) 557-4476 UAN'fl'('Y DESCRIPTION SKU NUMBER UNIT PRICE EXTENDED PRIG 61. FACfi 1X6X12 #2 T&G CARSIDING SQFT=LET X .42 141-1546 4.68* 285.48 This is a quote valid today. Upon payment this quote becomes a yard picking list subject to the terms and conditions below. Quantities listed above may exceed quantities available for immediate pick-up. Product is not held for a specific guest, but +nstead is available to the buying public on a first come, tu'st serve basis. Please pickup all purchases made on this picking list immediately. Failure to pick up products on this picking list today will result in additional charge to you if, on the day of pick up, the retail price of the products are higher than on the day purchased. Menards liability to you is l+mrted to refunding your original purchase pace for any product not picked up. Guest Instructions: I. 'l'ake this picking list to a cashier to pay for the merchandise. 2. Enter the outside yard to pick up your merchandise. (All vehicles are subject to inspection.) PRE-TAX TOTAL: 2 8 5 . 4 8 3. Load your merchandise (Menards "Team Members will gladly help you load your materials bid cannot he held liable for damage to your vehicle.) 4. When exiting the yard, presrnt this list to the Gate Guard. ('The Gate Guard will record the items you arc taking with you.) 5. Sign the Gate Guard's signature pad verifying you've received the merchandise. Our insurance does not allow us [o tie down or secure your load, trunk lid, etc. For your convenience, we supply twine, but you will have to decide whether or not your load is secure and if the twine supplied is snong enough. If you do not believe the twine will suffice, stronger material can be purchased inside the store. READ "I'HE'1'ERMS AND CONDITIONS CAREFULLY. All returns are subject to Menards' posted return policy. In consideration for Menards low prices you agree that if any merchandise purchased by you is defective, Menards will agree to exchange the merchandise or refund the purchase price based on the form of original payment. You agree that there shall be no other remedy available to you. If there is a warranty provided by the manufacturer, that warranty shall govern your rights and Menards shall be selling the product "AS IS." Oral statements do not constitute warranties, and are not a part of this contract. The guest agrees to inspect all merchandise prior to installing or using it. UNDER NO CIRCUMSI'ANCM:S SHALL MENARDS BE LIABLE FOR ANY SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES. MENARUS 11AKFS NO N'ARRANTIF.S, F.:XPRESS OR IMPLIED, AS TO MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. OF "1'HF: MERCHANDISE. Any controversy or claim arising out of or relating to this contract, or the breach thereof, shall be settled by arbitration administered by the American Arbitration Association under its applicable Consumer or Commercial Arbitration Rules, and judgments on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. The guest agrees to these terms and conditions through purchase of merchandise contained on this document. THIS IS NOT A RECEIPT GATE GUARD -SCAN HERE -> IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII - ~ PICKING LIST -GUEST COPY `STORE, tt 3(157 DUBQ PHONE,: (563) s56-s222 CASHIER- PRESS RECALL TRANS DUBQ 87825 s3oo D~d~;e 5creet EAx: (s~,3> ss~>-z7a3 AND SCAN BARCODE -_> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dubuque, IA Sz0O3 CASHIER: PAGE 1 OF 1 PLEASE STAPLE SOLD BY: BRANDON DATE: 02/15/09 RF,CEIPT HERE. GUEST NAME -ADDRESS -PHONE Heim, Deb 710 Peru Rd Dubuque, IA 52001 Ph: (563) 557-4476 UAN"i'I"hY DESCRIPTION SKU NUMBER UNIT PRICE EXTENDED PRICE 3 EACH 3/4"(7_3/32) 4'X8' AC2 TRPLYWD GC PAD 123-5090 31.98 95.94 _----_ This is a quote valid today. Upon payment'his quote becomes a yard picking list subject to the terms and conditions below. Quantities listed above may exceed quantities available fur immediate pick-up. Product ~s not held ibr a specific guest, but instead is available to the bu~ing public on a first come, first serve basis. Please pickup all pw~chases made on this picking hst immediately. Failure to pick up products on this picking list today wi I result in additional charge to you if, on the day of pick up, the retail price of the products are higher than on the day purchased. Menards liability to you is beefed to refunding your original purchase pace for any product not picked up. Guest Instructions: I. Take this picking list to a cashier to pay for the merchandise. 2. Enter the outside yard to pick up your merchandise. (All vehicles are subject to inspection.) PRE-TAX TOTAL: 95.94 3. Load your merchandise. (Menards Team Members will gladly help you load your materials but cannot be held liable for damage to your vehicle.) -_---- 4. When exiting the yard, present this list to the Gate Guard. (The Gate Guard will record the items you are taking with you.) S. Sign the Gate Guard's signature pad verifying you've received the merchandise. Our inswance does not allow us to tie down or secure your load, trunk lid, etc. For your convenience, we supply twine, but you will have to decide whether or not your load is secure and if the twine supplied is strong enough. If you do not believe the twine will suffice, stronger material can be purchased inside the store. READ THE TERMS AND CONDITIONS CAREFULLY. All returns are subject to Menards' posted return policy. In consideration for Menards low prices you agree that if any merchandise purchased by you is defective, Menards will agree to exchange the merchandise or refund the purchase price based on the form of original payment. You agree that there shall be no other remedy available to you. If there is a warranty provided by the manufacturer, that warranty shall govern your rights and Menards shall be selline the product "Ati IS." Oral statunents do not constitute warranties, and are not a part of this contract. The guest agrees to inspect all merchandise prior to installing ur using it. UNDER NO CIRCUMSTA^::'FS St1AL1. 11F,N'ARDS BE LIABLE FOR ANY SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES. MF.NARDS MAKES NO WARRANTIES, EXPRESS OR IMPLIED, A5 TO MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OF THE MERC'HANUISE. Any controversy or claim arising out of or relating to this contract, or the breach thereof; shall be settled by arbitration administered by the American Arbitration Association under its applicable ('onsumer or Commercial Arbitration Rules, and judgments on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. The guest agrees to these teens and conditions through purchase of merchandise contained on this document. THIS IS NOT A KECEIPT GATE GUARD -SCAN HERE __> Barry A. Lindahl, Esq. Dubuque City Attorney ~,~,,~ Suite 330, Harbor View Place 300 Main Street Dubuque, Iowa 52001-6944 ' (563) 583-4113 office (563)583-1040 fax 2U07 balesq@cityofdubuque.org February 5, 2009 Debra Heim 710 Peru Road Dubuque, IA 52001 RE: Claim Against the City of Dubuque Dear Ms. Heim: THE CITY OF ~ ; ! ~. DUB E s ~,~t„ ~+*~. If you wish to file a claim against the City of Dubuque regarding damage to your property on Peru Road due to a watermain break which occurred on Brunswick Street, we would request that you fill out the attached claim form and return it to the City Clerk's Office at the following address: Ms. Jeanne Schneider, City Clerk City Hall -City Clerk's Office 50 West 13th Street Dubuque, IA 52001 Once the claim has been stamped in by the City Clerk, it will be forwarded to the City Attorney's Office for investigation. Very sincerely, Tracey St cklein Paralegal Enclosure cc: Bob Green, Water Department Manager 1 i Vf l /I I lVli L4ii IiiJViA'.JII IiJi i.it i~iA YYi iVGI V 2370 Cherry st Dubuque, IA 52001 __ ___. __ Ivac~~~c / rt~+N1Ca~ "`~ iU QeX~ ~2c1. 551-4y~b P.O. # Terms Descri~xtion to remove dirt from yard to cut down small tree install seed on yard where needed by bag straw to cover seed and dirt UUIii~.Jil ilk. VI ail VIU Vlf i dl IV i VVR any changes will be extra charge bid good for 30 days Fromme/t Landscaping & Lawncare Date 2/16!2009 Estimate # 1 Due Date 2/16/2009 Other Qty `_ ~ Rate ~ Tatai 301 30.00 900.00 3 75.00 225.00 3 43.00 129.00 6 6.00 36.00 4 JG. VV i GV.iJV Subtotal $1,418.00 Sales Tax (0.0%) $0.00 Total $1,418.00 563-564-1240 ~. , ,: !" ; _. ~;. a yep •- ' ~ ~"1 r '1~, .~! ` i -~ ~ .:r '~ ..a _~ N'