Claim by George ClarkCLAIM 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 13t" 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 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: George Clark
2. Address: 3591 Crescent Ridge
3. Telephon
4. Date of Incident: ~~ /5 D
5. Time of Incident: ~ ~Or~~,,. ~f ~Cc~ D ~~
6. Locat' - n of Incident Be sp cific): ~ Corner of Crescent Court & Crescent Ridge
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.)
~~~ i ham, ~ l'~ ' e r~ ~ 1r ,.{~~ , ~ -i's~ ej~` a 'r` ` /E's ~~,~ ~j~
,/l/) fC-4-- ~'G uS ~ d~C i~1 ~~ i r r C-T~~`~~ \ '~ ~~6C1~'~.'C `eV (GS i D W c ~-~ ~2. /' n
,n r O. ~ ~ u ~-c' ("ct (z'<-zc~l ~7 I G r IC 't-~ ~ ~ ~C 475 c ,^ C"~ l ~ v~ ~•~*-~_ -f-,~ ~~ ~ °~
'Q ,~ C S r,1 ~ ~~ l.u-e ~2 Un ~ S C -p r~o ~ J
8. W ,, t were weather conditions like?
\(~,n~lr •~ c~r7
9. nGive name and address of any witnesses:
/l ).U;r~(n~nf C Q~~ 0r`z'~-2~~ ter-- ct. r~ i~~\ (.~G[''vl~~.~e'
10. Did police investigate? (If so, give names of officers.)
11. Wad 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 o,~ damage.)
13. W,kaat 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 Dubu ue?
I n~~ ( ~. ~t ~'~u cz G ~~.
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 i cident? (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 t i ~ a D U ~~~ ~ ~~---
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SER~`PR[3 OF' Ul'1~U(~GE F IIt>I~'~ RESTOR~11'IOV`, ~~iOLI) ~ti ~~`~~"hER _~H"1'[€~~~1T1O\
lU=[79 Timothy street
thrt~uque ta, 5?003
['bane 563-5~4-"?~~[''
Fat 563-SS~1-2373
Tar 1; X12-1 d7=}519
Client: Cieorgc Clark.
Propert}r: Crescent Ridge
Uuk~lu~ue, {A 52003
Operator hrfa:
Operator: `TERRY'
Estimator: 'I'errp Lenstra
Liusivess_ [079 'fivu~dly stre-et
Duht~ui>iie, [A 52003
'Gyps of Estimate:
Date Entered: LU12()i''20U4
Price List: ir1D[5I3 (1C'IU9
Restoratiort~Ser-~-ice%Renu~del
EstinlatG: 2009- [0-20-0931 CON
Uatz Assigned:
1•his estimate does not inclvdz, or is limited to any unforeseerr ~t.ark that may be nece.ssar~~ to complete this •job.
Sf+:tt~'1'i~O (}F L)~:BC~i~tlh: F[ItE i2~:S"[~Uit:'~~h10~', ~~10Lll ~ ~~'4~.1`I'Ehi?~li'1'1C~~11`t(~1'
I0~79 `CimothS=street
Uutwque Ia. 52tIQ3
['hone Sli3-58~F-2?-4l
Fax Sh3-5ti=1-?j73
Tax ft 4?- I ~7=1519
? Ittlr)-11--21l-U i)31 t' (~1`
:~1a111 ~eYe!
Sollrc•e C`eilirr~ Height: 8'
Dlissirr};1t't11L l -3'U" 1 8'11" Opens into Ltuuliut; Goey lr) hlool-!C'eil[n~
11'lissiul; ~~~all: ! -2'7" ~ (z'8" Operry iotoSlora~;e Goes io )loor
L1GtiC'RfPT'i01' Q\"C~` U\IT C'05T T~OT,~L
X18. R~tick l ~2" ilt3~tvalt - hun~. ta[)ed, ~~ ith smooth js~a11 finish 19'?.U7 SF {cr 1.92 = 3GI1.78
57. Seal then faint the walls i,2 coats) 320.1 [ SF (cE.;; 0.57 = 182.4b
~9. RJR Batt insulation - ~" - Rl ; 160.06 SF (~; O.S~ = 134.5
50. Seal wrth fool sealer 160.06 B~ ta.~ 3.25 _ 5~0.2U
7'he abo~~e is f<n- sealing exterior galls ater they hate been damage by° hydraulic pressure
5 L . C'ar'pentzr - Cicneral Framer -her hour 3.0U !-l It (cis 6.90 = f 97.70
52. It~~R Caret -Standard ~~rade. 139.49 SF {ci± x.31 = ;"'" ''?
53. It4l[~ Suspended ceiling systenj - 2' x 2' 1?b.i31 51~ (n` ?.~> = 3?3.36
Stor;)~e ('eiliu~ liei ;llt: 8'
\~l[ssilt~, ~~`all: 1 -?'T' \ 6'8" Opens info Sours-e Ewes io T`lrror-
~~lissul~ ~'1':-11: l ~3'!U" \ 8'0" Openy iu[c- ~"loset ~=oes to [door/Cei[ull;
i~'llyylrlr; ~ti'.1l1: (_ jru~e ~ (ir~ee O})eny inli) FSlinrh Grley Io 1'lUrrr
liissirl~ ~S`.~ll: I - 2' lU" \ G'8" Opens into Boiler Goes to ['lour'
ilESC'RTPT'i0\ (~\T'Y Iti1T E'OST TOTAL
~54. Itz~.[t C'arpct - Standard grade [09.'?8 SF (cr? 2.31 = 25?.44
l3oi}er C eilirr~ Height: 8'
ilisyiut; ~1`a!!: l - 2' lll" ~ (i'8" O}reny into Slorrtre Goes irl rlool-
1ll:SC'Rll'"1~}p\ ()~T'1- [`\I"f E'OtiT TOTAL
(i5. Scaf «~ith paot scaler 78.33 EA {tr' 3.75 = 254.57
`i'he abo~~e is for sealing exterior walls after they tlas~c: begirt damage by hydraulic pressure
68. [?t~[LCar-}~et-Standardgr~adc 75~)C) Sf~(a;: ?.31= 17.33
h~ruil~ Ceiliu~ Height: 8'
?Ol'I9-I(I-20-0931i`i)N 1 111,~'2UU9 pale: ?
s~r~~~~uc3 ~H~ ~~~=~~~~aLl>~ Fu~~; k>~;~T~ii:~~~~~c~~, ~~loLl~ ~~ ~~~~~~t~>~rt ~~u~r-~.a~°fo
10-179 Titni~tlty street
L7ubugttc; Ia. 5~0(}3
Fay 563-55=1=?373
Tai 1t ~?-1~7~1519
~iY~llti~ ~~'Otit~ AY~t75;
1 t)(i6.a~1 SF ~~Falls
333.05 SF' Floor
O.U(1 SF Long ~~~all
1s33.U5 Sl~ ~eilittg
91,3 S1' Flooring
2,735.x}9 SF \Valls and ~eiliny
?=13.17 Ll= Floor Perimeter
3fxl.UO I.F C'eil. 1'erinteter
3~??.U> Floor Area
1,053.33 E~teriar l'~'ail Area
O.QO Surface Area
U.OU Total Ridge Length
383,33 Total Area
131..67 Exterior Perimeter of
Walls
OAO Nuult~er of Squares
(1.UU Total Hip Length
l_9ti(~_4x1 htterior !Fall flrt'a
O.UO 'I'o(all'eritneterLeu~th
?UU9-1()-?U-0931CUN l f!11.~300t) Page: ~
- SERO'Plt() ()~' 1)C?BIQCs~ Fiit~: ItES'I~OIt:~"1'IO:'t, 1lOLU ~: \1~A7'ER alt"TIGATIO\'
lU=t79 Tirnuth5~ steeet
thrbu~~uc Ia. 5?UU3
['franc X63-j`4_?~~~
Fat 5fi3-S54-'Z73
'l'ax ii :~?- I X7451 ~)
Linr, ltem Totai
Material Sales Tax
Replacer~jrnt C'~~st ~"slue
`et Claim
4 tl ll7llt it d`~'
t~,fi37.t)5
fit; 7.UUU"~~ s 2,c~56.71 ?06.t}7
5(i,$4-l,Q2
Terry Lenstea
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SERYPRQ QF i)I1BUQliF: FIRE RESTORATi~ri, MOLD & ~4'A'~'ER Mi'i'I~ATIUh
10474 Ti~uottry s#rc~t
Puhuque l~. 52Q03
p4~one 543-584-2242
Fax s63-584-2373
`f'ax # 42-1474; t 9 --
Client; ~'ic«rg,e Clerk
Prxsl,erry: Crexe~t Ridge
1labuq~u, TA S~20U:i
t]~tcrator lnt4'
t7perator: 'fxltRY
T',stimxtur: T+crry Txnstra
Liusia~°ss: L0479 Titaothy atreal
i?abbuquc, 3A ~IOi13
Typc u#'F,stitnatc:
i?ati Entered: I Uf2012C1t}+~
Price List: iADUSB. U('TQ'9
Ttcxiut uti4td$Crui~Y;11~CmodC
Lati rnxle: 2009'- l f~ 2~t}~I3 I
Dote ASSignctl
Ruxint~ss: ~5b:i) 5R4-2242
Tkis ast~matc i#ues not mchuic:, ur is limilr.~l to any tmfot+cxnr~i wank drat Wray be neccsxary ba complctC this dab.
SIFRVI'$~ C1F ~7UBUQUL 1FiiR~ RESTURATI~JTiI, MUY.D & VItA"fER MiT[CATI~IV
10474 ');'tmo~thy stn-et
Lkthuquc [n. 52W3
Phant ~~~-~s;a-r~a~
l±ax Sb3-484-2373
Tax # 42- I d7di l9
2009-1i1-30931
Mgiw 1<,e.~d
Myiu Level
U~.~,~' ~C: kTI"i7OIV
Ty'I'Y UIVI'r C:[1ST 'YIi1T?lL
7hc fallowutg is lCecomtstended
-Aq carpet zu:rcis to be temovcd xrKl ~eplaccti it is cun~idered cotttarrrinated cat~ory 3. The ctixrtaminattan is the unkno4vn
materiaiy t}+at court in fmn~ t4+~ graejtad. fiePtieidzs •bt~~Ga-
-1111 damagc;i drywall should l-e rcrni+ved a>r~ repia~:cd a8 Deeded
-The west.vall of the home aceds ~ 4tc resealed,
SnursC IL:e~llal;'Height: 8'
Missing~':rll: 1 -3'0" X $'0^ OpenSfntaiarrding Goes 1o FI~+.rJCeiling
MiAai+rg Wsl1' i -I'7" X G'8" Upea~ intuStnratga (,ueu to F1ovr
DE,SCltll''1'[(?i~i [,tN7'~' L~TI' C'D~T TO'I'~iL
-Uemnlilion and water ~xtractian by others
-Drywall repair h}' utlters
-Patnt by others
I! T4rt• wept wall of iitis ru[nt~ w-t11 treed. In br re~airad it hxs boon damaged by tl~e l~ydr.-ul~c pre~vure fYO+n ih+s aGCttrrcncc, 'i7iiS
w ill netxi to hE; repaired by a wart~nxrfw$ cotmacecr.
i. Apply anti-ntiet~gbial~gcnt 22'6.8! SF ~Ci? 4.18 - 22.li3
3. G+.meral Demolition - [w`r honr 2.{111 HR {a~ 43.1+! _ li6.3~
'flte a~ve is for the iemuval afdama$,c dtyWall_
~C~iltsg Heigh; $'
5tarst~e
MlSgln~ WAiI: 1-3'll1" x ei'$" It7t0 i3aikr Goes to Fl0er
Missing WxIL L -3'f" X ~'S" Opena 1t-14 Fatoily {',,ors le Fiogr
i4iissi>t~ Wall: 1-~'~~" X g'~" i3~peos into [:I+set C,,,es to TrloorlC:4iling
?!i<is3ing Wall: t -Z'7" X 6'8" iyRe~s 1n#u Saurec~ t;aes to Floor
1]ES~IL'.1i~PTI4N Q1VTY I,TtVT[ (:OST TOTAL
-17C+nulitiptt and wxl~r e7[traGtran bX tethers.
-Uryvrall re.}yair by utheCS
-Palrit by nlitCrs
{). ,4pply anli~rnicN~+ia1 ag~t 99.j5 SF (a3 U.18 = i 7.$B
2009- I ~-24~i193 l I t},'20l2004 Fuge; 2
SERVFFr~D OF piTSlrQilrE FIitE RI+.ST(~RAT'iUN, l1~tO~I>« ~ WATEit ~rrrr*A7i+~Iw
:.r :i oa•r• r::M h~nr..~1
ll?474 Timothy street
Tiuhuque ia. ~24Q3
Phone 5{~-584-2242
N'ax SC,'~-554-.237:i
Txx # 42-14745th
~~~, t:eillo~ Aeighc; ~'
Muxing V4'.11: ! -Z'l0" X b*S" (3peaa 16tn 3lur~e t~ to F'lt,or
D1;SCli~t"['if11+1 Q1VTY UNTP CUST TUFTAL
--Il~mtslition and water cxtsactino ~7f viers.
-Drywall rGlJ~1r by t,tl,crs
-Paint by nlhen
i l ~ The weak wall of this rtKnn will noGti to be n~uimL It bas bees tlannxs~ti by kite bydrxsdit: lrlxssttrc $om t~+is t~c~vslence. ~1'his
will need to be reI-dired by a waterprtxtl':ng eu~-dctvr.
11. Apply xnli-microbial agent 69.(!Q u~ ~~ 0.18 = 1.2.42
10. Creucral ilcmoliliun - per tour 0.54 HR {~ 43.14 - 21.60
The akx~vt: ih fur tlta removal t,f ~tua~e tttyvt'a11
~L'luses C:ei;fing ~it~igh t: 8'
Mis®ing Wa!!: l -3'1~" 7iC $*Q" Opens ftttoStnr>gc 4;o~s to F1o,rrl~cilbng
DI~C:ItIiE''TTU!Y Qom' Il'h~T C[}5T T(]TAL
l2. Apply anti-~nicrobial agent 32.I0 SF {r1a 0.18 = 5.~J2
-ik:molitltm and wxtt-r e~acttnn by oti,erx.
F'auuly
MLaxin~ Wall: L ~ 2'S" X tz'~"
Missing Wall: 1- 3'Q^ X 6'll°
~'yabraom 1: L#n~eg
Missipg 4Va11; ; -g'p'" X R'~"
n4~ssing wan: I -~'~'" x ~'~^
1>rF~cTI~U!~
Gelling 1Reight: 8"
6 iota 1Fntty C,aCS to Fltrur
f~peas iah $tst'~e Gass t4 Flner
Cc7itrR Htigltt: #i'
Upeds ~idta S~rce Goes to NLoo~rlCeiliug
(?pets ini• Faatty t'rvrs to izLn.rlCailini{
~t+l•I'Y FINt't- Cf1.ST TUTA'[.
-Denralttion xn~l wakes rxiraCtitxt by iNhrfS.
13. Apply anti-CniCrtJ#,i81 agent 356.92 SF bus 0.18 = 64,25
entry
lVllssing ~'~:
UE~~'1e~1P'1'fOi~F
Crilittg height:ll'
I _~+{~~ X b~g~' tl-pea& into Family t'.,n71 [a FLt+~r'
{~}~y~'y I3hTi' BUST TQ'1'Ai.
2009- I i}-70-1393 t I t1f2012Q09 Px~,tr. 3
SERYFlEtU ~F UU~~QlJ~? F~'RE RES'l't~RAT~UN, 1N[]LD ~ W A'TE$1V~iTj[~ ATY~I~
~I':^nnr r.. .: moat::~
11W79 Tir~wlhy stt'Cer
f3uhuque la. 52(lpi
Phone 5bi-SS4-2.42
Fax 5~r3•~~1-?.373
Tax ?' d2- I d?451 ~
CQNZ'lI'~1~'D -Entry
DESC.#rri'Ti+DN
t~l+iTY l':ItiTi ['flST T(}T~1L
Demolititan sod water ex-tractiuri by others.
~ .APP1Y ants-micn~hial ugent 137.Ob ST (ril U. i R _ 1A fi7
The all caf tkufi room will need to be demolititmed. Ut~gaing wat~-r intrusion from phis evtot hascxused owing drywall -
dam a~~
~I~~TCI~NENT
[lESCRIPTION Q~~ tlNi'1'CAST T(}TAL
1 G. Lmer~v-ncy service cxLt - aRer busiacss E,our~ 1.{ln ~ (d; 1 irs.Stl ~ lC>>.80
~ 7. r•.yuipmcnt setul+, take a4~p,,, and muniWSing (no~rrly ~~~,~~~ 4.OI1 Fire ~ 79.73 = ~ 58.4?
37 llehumi~li{ier ~per24 ho1~r Period) - 3~,arge -A1o nttxutorin}; 3 0[1 DA {~ lOl.ZS = 3g3.7S
.
38 f7c:hutwdifier {per 24 hour period) - ?7 arAc - *tQ mQnituring 3.U1} 1]A (a's 101.25 - 3{~~.75
.
39 Air movcT (pct Z4 hour pcriiKl) - No rnonitnring 3.0017A ~~ 24.Z3 = 78.{i'~
.
d0 .fir n~ouer Iper 24 hour pe},od',# -Nti monito~t'rstg 3.QU UA [~ 21.23 - 7R.~i9
.
d i Air mavcr per ?4 hour pcrincl) - No awnitrxing 3.410 DA fak 2G.23 ~ 721,6y
.
42_ Air mover (per 24 4n~ur pcstod) - Nu monippt~ng
~F3 Asr mover (Per ~4 hour pc~iiHl) - IVO mAnilnring 3.4HI DA (a; 26.3 = 7S.bH
.
44.
Av mover (pCr ?4 itaur period) - Tlir neonitodtng 2G.2:3 • 7$.C~9
Qf~
Air move[ (pct 24 hrnjr period) - l~to m~initutiog 3. W DA a xb~3 5 78.b9
.
45 Air mover fPcr 24 hmtr pgricx~ -2do t'nonitcxing [i 410 i]A (~~ 2ei.23 - 157.311
.
~{7. Air muvCr (}xr ;;?4 hnur periods - No mixuturing ~i.i1Q ~A C~ 2b-23 = [17.38
Adjuxtmetrt~ for D~axe ~rvice ~:hit~eB eldjna~tmeut
L'.9exning RelzYedisLinn Technician ~ ~ ~ 7y.4(i
79.dCr
Tutul Ad~ustme.~ts for Rase S~a-vice Charges;
Liee 1#em Tulxls: 7,@Og-t(I-I4-Q9~t
20U9- { 0-2 01143 1
Z,133.Z2
SERV~'RU ~F iIIT$U~U~ FTCtE ~,y'TCF'R~-'~(]N, MOLD & WATF~ '~~ATlt11~1
1U479 Tirnnthy alreet
L]Ubutpie Ix. 52UU3
i'htsne SG3-5li4-Z?.42
Fax iCs3-584-2373
Tax # 4?-14?451
Grand Tokxl Arca~a:
1,~ti6.44 SF Waits
82Z.U5 S~F Flistsr
o,UU SP L,nn~, Wall
S2'?,U5 Flrxsr Area
I ,053,33 L-'.xiCri4rW~11 Ater
q,q{} ~unrf~cr: Area
0.00 Tonal Ititlge i~~,ttt
?{104-1 U-20-~?31
$22.05 SN +Ceilin6
41.14 5Y FloonnR
U.tIU SF Shim Wall
SS$_33 Teslstil Ares
131.G7 Lxtcripr F'rriuse~cr of
Wx115
0,00 '~ixsmbu of 5gnares
0.00 7'artai Faits i.ei~th
2,78$,44 ~F Wa!!~ xnd Ceiling
24.17 LF1rIaorPcrim4ter
264 i70 LF Cell. Perimeti~r
1,96Cs.44 Inten4r ~1r'aH Arcs
Q,QO 7'utdl Pcruneicr LcngGli
l0l2~?009 ra};c:~ 5
SERVPR~ [1#~ U[]R~IQ[T~ FIRE ~~ST[?i~.A-7"E~I~V, l~taL]] ~i ~vATF~[ ~vn~Y~ATiU~N
.~ . •~n~ -rerhgmeca;l
f 047 Timalhy nlrecl
I h~buyue Sa. SZ04}3
Phone SG3-5~1-21d2
1';~ 54i3-~8d-2373
Txx # 42-147x1519
.Sgmmary
L+ne 1ten1'I'otdl
Tcrixl Adjust~E~ettts for Base Scrvire L'harges
Maicrial Sa1ex Tax {~. 7,(11,IU'r6 ~ 16.43
Replacement Cuss Value
let i'laim
Terry T~xira
~,OS 3.?!,
7SI,4ti
1.15
S3,i34~7
~2,1~d.37
~UU+~-I4~2(1-b931 111!2.4}120[1'? Page: G