Claim by Nancy GoeckeTHE CITY OF
DUB UE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
43',p
To: Mayor Roy D. Buol and
Members of the City Council
DATE: August 10, 2010
RE: Claim Against the City of Dubuque by Nancy Goecke
Claimant Date of Claim Date of Loss Nature of Claim
Nancy Goecke 08/10/10 07/23 & 07/24/10 Property Damage
This is a claim in which claimant alleges that her basement was flooded with water and
waste after the heavy rainfalls of July 23 and July 24, 2010.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
John Klostermann, Street & Sewer Maintenance Supervisor
Gus Psihoyos, City Engineer
Nancy Goecke
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
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CLAIM AGAINST THE CITY OF DUBUQUE, I O�
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 13 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.
J
1. Name of Claimant: G L F v- / V AWG 6.-6E (....Ake
2. Address: 10 /(7 V) h j c 5-1
3. Telephone Number 3 3 ,5/3 - 6
4. Date of Incident:
5. Time of Incident: ✓ (,� a�f Lt./ ) 4I
6. Location of Incident (Be specific): / 1j
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.)
8. What were weather c ditions like?
9. Give name an A l addre s of - witne ses:
10. Did ' ve�e? (If so, giv ; names of •fficers.)
Itk 0 /L � ,_' , ._• _ ice__ /
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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.)
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 laim rom the City of Dubuque?
2
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 amouryf?
Dated this b day of
(Signature)
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(Print Name)
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1660 John F Kennedy tso 2610 White St #3
Dubuque IA 52002 -5106 Dubuque IA 52001 -3350
(563) 588 -9000 LOC: 1325 -M
(563) 513-0861 MAP CODE: 201 RT: 01
RENTAL- PURCHASE DISCLOSURES
The following disclosures are required by the Iowa Rental- Purchase Act to help you understand the terms of your rental -
purchase agreement.
1. DESCRIPTION OF LEASED PROPERTY: YEAR NEW USED
ITEM QTY MODEL# SERIAL# 2009 USED
0132505376 1 WTW5100VQ CY0732442 2010 USED
0132505847 1 WED5100VQ MY5085835
2. CASH PRICE: $370.31 Lessee Initial
This is the price at which we would sell the leased property listed above to buyer on the date of this agreement.
3. TOTAL OF SCHEDULED PAYMENTS: $740..61 Weeldy
Lessee Initial
The total of scheduled payments means the total dollar amount of lease payments you will have to make to own the
property. This total does not include additional charges which might be made during the agreement such as late
payment charges or the optional liability damage waiver fee. See the remainder of the contract for an explanation
of these charges. Free rent allowance will not reduce total rent or purchase- option amounts. Sales taxes are subjec
to change in the applicable tax rate.
Weekly If you choose to obtain ownership through weekly rental, you will make 40 payments: the initial
rental payment of $.00 , 38 weekly payments of $18.99 and a final payment of $18.99
total of $740.61 in rent and sales tax of $51.87 for a Total Cost of $792.48 .
Semi- If you choose to obtain ownership through semi - monthly rental, you will make 19 payments:
Monthly the initial rental payment of $.00 , 17 semi - monthly payments of $41.11 and a final pay
of $41.11 for a total of $739.98 in rent and sales tax of $51.84 for a Total Cost of $791.
Monthly If you choose to obtain ownership through monthly rental, you will make 10 payments: the initial
rental payment of $.00 8 monthly payments of $82.27 and a final payment of $82.21
total of $740.43 in rent and sales tax of $51.84 for a Total Cost of $792.27 .
Payments will begin on Jul 26, 2010 and each renewal will be done on the Monday of each
Week TOTAL:
4. INITIAL PAYMENT:
A. Rental Payment: $.00 C. Optional Liability Waiver Fee: $.00 $.00 Tax: $.00 D. Tax on Optional Waiver Fee: $.00
5. OWNERSHIP AND LIABILITY FOR DAMAGE OR LOSS: You will not own the property until you have made all of
the payments above (unless you choose to "buy -out" early as explained below). If the property is lost, stolen,
damaged or destroyed, you will be responsible for the fair market value of the property at the time of the loss or
damage.
6. ARBITRATION: An Arbitration Agreement comes with and is incorporated into this rental purchase agree
You should read the Arbitration Agreement before signing this agreement.
NOTICE TO LESSEE - READ BEFORE SIGNING
1. DO NOT AGREEMENT, AND ANY WRITING ON THE REVERSE SIDE, EVEN IF OTHERWISE ADVISED. THE ARBIT
AG RE ,
2. DO NOT SIGN THIS IF IT HAS ANY BLANK SPACES.
3. YOU ARE ENTITLED TO AN EXACT COPY OF ANY AGREEMENT YOU SIGN.
4. ANYTIME AFTER YOU HAVE MADE YOUR FIRST WEEKLY/SEMI- MONTHLY/MONTHLY PAYMENT YOU
HAVE THE RIGHT TO EXERCISE AN "EARLY BUY -OUT" OPTION AS PROVIDED IN THIS AGREEMENT. IF
YOU CHOOSE THE EARLY BUY -OUT, THIS OPTION MAY RESULT IN A REDUCTION OF YOUR TOTAL COE
TO ACQUIRE OWNERSHIP. IF YOU BUY -OUT EARLY, YOU WILL PAY: ( "CASH PRICE ") minus (AMOUNT
OF LEASE PAYMENTS THAT YOU HAVE PAID ALREADY multiplied by 50%) = Early buy out option price.
In addition, you may purchase the property within the first 90 days after the date of this agreement by payi
an amount equal to the Cash Price minus the total of all rental payments (excluding tax) made by you, plu.
5. IF YOU CHOOSE TO MAKE WEEKLY OR SEMI - MONTHLY RATHER THAN MONTHLY PAYMENTS AND YO
USE YO� i EARLY BU�UT OPTION, YOU MAY PAY MORE FOR THE LEASER PROPER / /�
LESSEE / / � ' DATE: ' > U
LESSEE DATE:
LESSOR. DATE:
Rental contract pledged as collateral security to Chase Manhattan Bank as an administrative agent for the Bank group. IA 08/04
E -Mail
GJ
r Wet( Phone , 3 _ 01 r3
Home Phone — Cr if- 6 +
We hereby propose: ❑ To fumish and install the following listed products. All work to be performed by professional technicians according to standard
work practice and codes as set forth in this proposal.
FUR
�.r !i— h9adei�
OP
❑ ❑
❑❑
A B
❑ LI
❑ ❑
❑ ❑
❑ ❑
Other
Other
Total Cost after Rebate(s)1 Discounts)
This Proposal is valid for
4 1
FILT ON
1" Throwaway ❑ 4" - 5" High Efficiency Media Filter
❑ 0 HUMIDIFIER Model
PIPING
Condensate drain hook -up to existing cC
Condensate pump ❑ New ❑ Existing
Refrigerant copper lineset - Nitrogen tested
❑ New ❑ Existing
❑ ❑ Gas piping package - gas valve, union, drip tep is
❑ Gas pipe from %sf° fi3�C
❑
ID La Gas pipe pressure test
❑ dapt to existing PVC ventin ❑ New concentric termination Itd'C�
❑ New PVC pipe to ad5 f. - of house.
0 metal pipe to existing lined chimney
❑ ❑ New inch chimney liner assuming existing
chimney is straight and can be lined
AIR DISTRIBUTION
Plenum modifications
Supply 0 Retum
❑ New supply plenum New Return Drop w r n^
New supply diffuser(s): ceiling 0.4 y
sidewall floor G <r*.. ( ;
New retum grille(s): ceiling
sidewall
Flexible radial piping
❑ Non insulated ❑ Insulated with vapor barrier
floor
❑ OPTION A (initial) �� °-
Amount due Patterson, Inc. $ a
Utility Company Rebate (elec) $
Utility Company Rebate (gas) $
Manufacturer Rebate/Discount $
Other 5 s r-
$
$
/ NOTES /a.�
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Customer Signature Date
days.
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$ f b •
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FURNACE
Model /T `
❑ ❑
❑ ❑
0
❑ ❑
❑ ❑
A B
❑ ❑
❑C
❑❑
Company Signatu
Digital programmable thermostat .- 4,5 e. err • - f so
Easy to see non - programmable thermostat
Humidistat
Control wiring
New weatherproof disconnect with flexible connector
L3 Condenser wall bracket 0 Condenser pad 0 New ❑ Existing
gerant filter drier
I work done in accordance with existing codes
equired permits
Re oval of existing equipment from the premises
W ther resistant vibration proof isolation pads
ork to be done in a neat and professional manner
Clean up premises and remove debris at conclusion
of each day's work
hour emergency.service
❑ ❑ Condenser cover
❑ Compressor
❑ Condenser
❑ Evap tor Coil
umace
OPTION B (Initial)
nt due Patterson. Inc.
UtiIi Company Rebate (elec)
Utility Company Rebate (gas)
Manufacturer Rebate/Discount
Other .S 4 1%
Other
Other
Total Cost after Rebate(s) 1 Discount(s)
jr 7•-
(Color)
A B
1 year Patterson Parts and Labor Warranty
Manufacturer Warranty: Parts Labor
yrs—yrs.
Yrs. yrs.
yrs._.Yrs.
_1• yrs. =yrs.
xrty�
eat Exchanger ifetimg _ µN
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Optional Coverage�� � r rr�r
c� et" n
❑ — years rrfanufacturer labor warranty on Fumace ' A"'
❑ _ years manufacturer labor warranty on 1R 1 'Ili
1 have authority to order the work outlined above. I agree that the Seller retains title to equipment fumished until final payment is made. If payment is not made
as agreed, Seller can remove said equipment / materials at Seller's expense. Any damage resulting fr . id removal h . 1 no the responsibility of S Seller.
Date y
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Date ... , t. .
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Name ri /7 7 C Phone
Billing Address
City, State, Zip
CHECK LIST:
1.
2.
3.
4.
5.
6.
7.
Proposal
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Installation shall also include all items checked below:
❑ New — Amp Disconnect ❑ Install Refg. Driers
❑ New — Low Voltage Wiring .11( Permits
❑ New — Equipment Pad ❑ New Plenum
❑ New Equipment Pump Ups %.New RA Drop & Boot
❑ New — Refg. Lines Ft. ❑ Combustion Air Louvers #
Location of drain:
Size & type of common vent:
Location of vent termination:
Liner needed:
Electrical breaker /fuse type & size:
Clearance OK? All clearances checked:
Dubuque area:
1840 Radford Rd.
Dubuque, IA 52002
877 - 757 -7577
563 - 583 -4256
Job Address
f
How did you hear about us
Customer's Utility Company: .li"Aquila ,J 'Alliant ❑ Other
EQUIPMENT SPECIFICATION
UNIT ,y MODEL // SIZE EFF NOTES PRICE
f ✓
MISC. $
h re) - 101 L-
We will furnish, install and service the equipment listed above at price and terms on the proposal.
/ 1
Warranty: Labor J Yrs. Parts f 0 Yrs. Compressor Yrs. HT EX e— L Yrs.
BASE PRICE TOTAL
i
New Vent Pipe 2
4 Remove Exist. Equipment
.'`Clean Up
❑ R.A. Filter Rack
lir Meets All Codes
" /. ( e
C c g 5 * .f4 ()pi/
$ A /f r) y ' �'
,N" Start Up
AI -Sales Tax
.a" New Drain Hose
1
1
II
Terms: i ` _.. ;.. / BASE PRICE � ,,` ; $ - J
Accepted by (Customer signature): OPTIONS # •'' •� 6 s. i 0 sr
Proposed by: ,�f "' r ,': c ,' DI — {S '
,e` s r
Service Technician: NET TOTAL $ r E:� /'` (. ;
Proposal Expires in: DOWN PAYMENT $
Utility Cash rebates: $ Li ` BALANCE DUE $ "" � i' , e l[!
�/ - UP N COMPLETION
3/06 PROPOSAL , ' r. 1N
ii/ NI trice Copy YELLOW Customer PINK Sales
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