Claim Asbell, Mary M.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: Mary M. Asbell
2.Address: 230 East 15th Str.
3. Telephone Number: 588 1733
4. Date of Incident: 9/25/02
5. Time of Incident: Has been going on from 9/23/02
6. Location of Incident (Be specific): Sewer line between 14th /15th Collapsed or Tree Roots (Not Sure)
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 called Service Master and they said it was raw sewage so they pumped it out The next day basement had sewage in it, so
I called Jaeger Plumbing. They sent John McCann to check. He said it was City's problem. I called my son, Richard Asbell. He brought two pumps and started pumping into Manhole, waiting for City crew
to show up. They came and tried to clean out main but couldn't get it odne. Finally the next morning they had all kinds of equipment in the alley.
They told me they made some big repair.
Thank you, Mary Asbell
8. What were weather conditions like? Normal
9. Give name and address of any witnesses: Richard J. Asbell (son) 2401 Roosevelt, John McCann Jaeger Plumbing
10. Did police investigate? (If so, give names of officers.) I di call the Police to contact City Sewer Crew
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 Water damage
13. What other damages do you claim, if any?
No
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 not at this time.
15. What amount do you claim from the City of Dubuque?
Service Master for $587.24 and Jaeger Plumbing for $106.00; Total $693.24
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.)
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 5th day of November , 2002.
/s/ Mary M. Asbell
(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 d
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: ~)~g r~? ~£L/~
2. Address: z~'b ~3;-1' J ~'-'P~ :ST,/..
3. Telephone Number:
4. Date of Incident:
5. Time of Incident: J~
6. Location of Incident (Be specific): ~'EyE(L z.7.~E ~E-r~E-E~ /'~5'Pr//5'-/~/
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE.
full details upon which you base your claim.
employee's name.)
(Give
If a City employee was involved, give the
8. What were weather conditions like? ~/~Jh~/--
9. Give name and address of any witnesses: '~/C.~/~43 ~
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injures).
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 /4~'~'~ ~-,~ , 20 ~.
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
Ser 'ce %
ServiceMaster of the Key City
1845 Washington St.
Dubuque, IA 52001-3662
(319) 557-1488
Invoice
DATE INVOICE #
9/25/'02 ! 112948
BILL TO
Mary A~bell
230 E. 15th S~reet
Dubuque, IA 52001
SHIP TO
P.O. NO. TERMS PROJECT
DESCRIPTION QTY RATE AMOUNT
Eme~'gency Service CalVSewer Damage: 554.00 554,00 t
Dubuque Local and Slate Sales Tax 6.00~ 33.24
Federal 1D~42-1429160
' ' Total
' , ~ : -. , $587.24
ServiceMaster of the Kev City
1845 Washin~on S't
Dubuque, L~ 52001
319~-557-1488
Federal Identification #42-1429160
ASBELL
Room: Basement
I. MLD PPER
2.00 EA
2. WTR PPE
2.00 EA
3. WTR ESRV
4. MLD
6.00 HR
EQD
1.00 EA
STRUCTURAL
+ Replace Respirator - Rubber mask w/dual cartridge - Disposable
7.24 14.48 2
+ Replace Add for pemonal protective tyvek suit (sewage cleanup)
18.24 36.48 2
+ Replace Emergency service call - after business hours (2 men x 3
hours)
80.04 480.24 6
+ Replace Equipment decontamination charge (one time per job)
56.04 56.04 1
STRUCTURAL TOTAL
587.24
ROOM TOTAL: Basement
587.24
AREA STRUCTURAL TOTAL
587.24
Line Item Totals: ASBELL
587.24
~.00 LF Floor Perimeter
0.00 SF Long Wall 0.00 SF Short Wall 0.00 LF Ceil. Perhueter
Mary Asbell Page: 2
15E058-932 XXXXX W~er $0.00
Insured:~
Ins~ed: Iv'tory Asbell
Home: 230 E. 15th St.
Dubuque, IA 52001
Dates:
Date of Loss: 9/19/2002
Date !nspected: 9/19/2002
Home: (563) 588-3187
Date Received: 9/19/2002
Price List: CURRENT
Estimate: ASBELL
Jaeger
PLUMBING & PUMP. [NC,
17448 S. John Deere Rd.
Dubuque, IA 52001
Phone (319) 583-6677
Fax (319) 583-5495
IINVOICE I
DATE iNVOICE
10/24/2002 5967
BILL TO:
Mary Asbuilt
230 East 15th Street
Dubuque, IA 52001
hO. NUMBER TERMS PROJECT
09/23/02
Due on receipt
QUANTITY DESCRIPTION RATE AMOUNT
2 Labor
Sales Tax
tJred~t accounts are due on Me 1st of Me month. Maximum credit (gU)
days, 1 1/2% service charge on all past due accounts.
50.00
6.00%
100.00T
6.00
TOTAL $106.00