Claim Schreiber, John D.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: John D. Schreiber
2. Address: 550 Cooper Place
3. Telephone Number: 556 3479
4. Date of Incident: 2 16 03
5. Time of Incident: ongoing since 2/9/03 - 2/15/03 also 1/26/03
6. Location of Incident (Be specific):
Backflow of Sewage into our house (floor drain; shower)
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 just did it (above)
8. What were weather conditions like?
Not to bad but the Rooter Rutter man could not chip enough ice out to find out where it dumped into your City line.
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
I did call Dispatch; that's what got the sewer crew up here.
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Not sure yet; My dog licked up some of the tainted water!! Ok now 2/24/03
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.)
Homer 2/8/03 Downstirs Pot (Toilet Plugged) Pulled stool and snake ... Finally got in kind running Mon 2/10/03 I spent a lot of hours; snaking out the sink, stool, laundry room - kitchen sink dumps into it.
13. What other damages do you claim, if any?
A lot of cleaning up!
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, why make a claim to my ins. comp.? It's the City's Fault Roto Runr said.
15. What amount do you claim from the City of Dubuque?
$475.00
16. Why do you claim the City of Dubuque is responsible?
Your sewer was not cleaned out; it was plugged flushing the waste into our house.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 24 day of February, 2003. .
s/s/ John D. Schreiber
Buy the way your dept. cleaned out the one lower Monday 1 27 03 - Hope they did the won oup the street.!
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
Feb 2.4 03 OS:34a 4[ZZZLT,'~? p.1
r--- N0.0073 ~- 3/4
Feb.24- 2002 9:55AM BARRY A LINDAHL, ESQ
CLAIM AGAINST THE Cl~ OF DUBUQUE, IOWA /
~is w~en repot constitutes' your claim against the C~ of Dubuque, Iow~ You should
complete this form in full and a~ch any additional info.etlon that suppo~s your clai~.
T~ Claim must be fll~ with t~ CIW Clerk at City Hell, 50 W. 13~ S~. Dubuque, lA 52001.
It will then be referred by the Ci~ Council to the appropriate depa~ment for inv~tigati~.
Once t~t investigation is ~mpleted, a repoA and recommendation will ~ submi~ed to the
C~y Council. You will be provtded with a copy of that ;e~ and mcommendatioR.
N ON ALL C~IMS IS MADE BY THE C~ CouNCIL NO EMPLOY~
THE FINAL DEC1SIO ........... ~ ~n ~ KE ANY REPRESE~ATION TO
n; ~E CITY F DUBUQUE HAS ~Hc Autn~-~., -~ ~ ....
;~S TO W~HE. YOUR CLAIM WILL OR WILL NOT BE .alu.
7. OESC~6E ACCIDE~ OR OCCURRENCE THAT CAUSED INJURY OR D~MAGE.
full ~tai~ upon wh~h you ~$e your claim. If a Ci~ empio~e was involve; give t~
employee's
8. What were we, thercondltio-sllke? A~ ~% ~P
9. Give name and a~dress ~ any w~n~s:
Feb
2.4 03 0~):34a p.2
Feb.24- 2003 9:55A~ ~ARR¥ A LIN~AHL, ESO ~0.0073 P. 4/4
any damage done to ~ro~? (Ii so, descd~ prope~ and t~ e~nt of damage.
13. What other aamages do ~ou claim, U any? ~--
14. Ha~ you ~n com~nsated for any ~ or ali of your claim by =n~ insu~n~
company? (If ~, 9ire name and address of insurance compan~ and amount p~d.~
_ 7
15. What amount do you claim from ~e C~ of ~b~?
Why do you claim the City of Dubuque is responsible?
I~. HBVe ~ou ~d~ ~n~ claim ~g~inSt ~o~e ~l~e ~OT d~m~ges
yes, gl~e na~ a~ 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 _ 2 ,q. day of
/ (Signature)
_P//~/o'~ (Pn.t Name)
(Rev. 1100 & 7/01)
Feb ~ O~
09:3~a