Claim by David J. SchmittTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN ~p
PARALEGAL `7~/~
To: Mayor Roy D. Buol and
Members of the City Council
DATE: March 19, 2009
RE: Claim Against the City of Dubuque by the David J. Schmitt
Claimant Date of Claim Date of Loss Nature of Claim
David J. Schmitt 03/17/09 12/28/08 Property Damage
This is a claim in which claimant alleges that a City sewer line which was clogged,
caused the sewer to backup into his rental property at 1295 Thomas Place.
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
John Klostermann, Street & Sewer Maintenance Supervisor
David J. Schmitt
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 / EAnAIL tsteckle@cityofdubuque.org
~ ~~ ~.
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 West 13th 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 aU 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
vrhether your claim will or will n~,t nP paid.
1. Name of Claimant: ~ av ~ c~ ~ . S c1A ~ ~ ~~'
2. Address: 3~y~ Q ~~ e~5 5+. ~ wl~ucgP. ~A. 5?DOa
3. Telephone Number 5~ 3 - S 81 - o ~~"~
4. Date. of Incident: /~ `020 ~ (~ ~' ~h~~, ~~-~ y -~ 9
5. Time of Incident: ~ ~ ~~
6. Location of Incident (Be specific):
bu
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{~ ame.) II •• n
Q;oeS -Fa hoy~'e.~,Jey'~ ~d.~K~nq uv. Ca~.~ +~Df'a -~p~~'. ~~~
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8. What were weather conditions like? ~~ ~~~~'
h fer
9. Give nam a d address of any witnesses:
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~i-~'~ G'~'~..V' - a./~e ov- ~ ~ ems- /~D. .X 1.f"" Q;. ~ ~' S,1~~
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10. Did police investigate? (If so, give names of officers.)
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11. U1(as 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.)
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13. What other damages do you claim, if any?
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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.)
1 ~. What amount do you claim from the City of Dubuque?
yo 75
16. Why do you claim the City of Dubuque is r ponsible?
FJ e r n e lie ~. hoe -4' e via a~t ~+
4"' X121' ~ n ~ o c i YV1 eu> ~ C'S ~ tl `~
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.S wu5 -F e pvb ew, a-nd .f was caused by 1~~ ga~upl~~ aid G ma rh~f~
17. Have you made any claim against anyone else for dama es as a result of n
this in ident? (If yes, give name and address.)
v
18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Da d this a.~. day of F ~ ~uaV-~/ , 20~. C)
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AND ASSOCIATES INSURANCE
Dubuque • Bellevue • 888-556-6660
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CIPINNfLL~IUAL
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u www.Ludovissyandassociates.com
Locally Owned and Operated ~O~O~
HORI{HEIMER PLUMBING, INC. ROOTER®
D.B.A. ROTO-ROOTER
SEWER-GRAIN
SERVICE
" ~nd {way GJo ~2oudles gown r.Ae rDzatn "
P.O. Box 1533 • Dubuque, Iowa 52004 • Phone 563-552-1828
• N Camera Inspection 8~ Video Recording
• High Pressure Water Sewer Cleaning • Electric Sewer Cleaning
CUSTOMER'S
ORDER NO. DATE - 20 '
NAME- '
ADDRESS ~ ~ ~~
HERE'S THE PROBLEM I FOUND AND FIXED. CHARGES
YOUR: WAS CLOGGED BY: . " ;~ sink .............. .........................$
^ sink ^ grease
^ tub or shower
^ food tub ................ .........................$
^ toilet ^ paper or sanitary products toilet .............
.. .........................$
^ laundry I washer lines ^ hair .:
,:_ -, floor drain
$
^ floor drain ^ lint g, .....
j .........................
^ septic tank line ^ tree roots '" ` ~ laund
ry .........
......................... $
flnaainsewerline
`
^foreignobjects
`
^ other
'.
^ sludge styptic line ..... .........................$
_ ,~.
^soapresidue t~
m2in sewer
$ ,...
° ---
:::
.
Bother
..
.........
.............
$
" $ _.
TOTAL FOOTAGE CLEANED• KNIVES USED ~
y
W
JOB DESCRIPTION AND REMARKS:
`` $
__ . r ~ ~ $
TOTAL ~. ` ` ~_
~- ~ r r
CUSTOMER SIGNATURE OPERATOR SIGNATURE
CURRENT 30 DAYS ' 60 DAYS ~ DAYS AMOUNT DUE''
PLEASE PAY FROM THIS INVOICE
A service charge of 1 112% per month (18% per annum) will be charged to all accounts past
30 days. Costs plus reasonable attorney fees to be added incase of suit for collection.