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Claim by Cindy SanchezTHE CITY OF DUi1JE MEMORANDUM Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL ,s1J3 To: Mayor Roy D. Buol and Members of the City Council DATE: August 18, 2010 RE: Claim Against the City of Dubuque by Cindy Sanchez Claimant Date of Claim Date of Loss Nature of Claim Cindy Sanchez 08/17/10 07/22 & 07/2310 Property Damage This is a claim in which claimant that heavy rains that occurred July 22 and July 23, 2010 caused water to back up into claimant's basement at 3000 Carter Road. 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 Cindy Sanchez 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 CC; M CLAIM AGAINST THE CITY OF DUBUQUE, IOWA 4-Y- This written report constitutes your claim against the City of Dubuque, Iowa. You- -J oA i , 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. 1. Name of Claimant: , /VC! 5;4 ‘e-- - Z— 2. Address: ,f7Z5 3. Telephone Number � ��� w y/6 4. Date of Incident: o?v, _ J 3 -c40/`? 5. Time of Incident: 6. Location of Incident (Be specific): D 4./ s c . o 2 acv/ N • ..a;"! 9. Give name a d ad ess of any witnesses: �J J, A) - 7 e 7 � � � �2 / / 4-.4 10. Did police investigate? (If so, give names of officers.) Ties - ,� c � 7. Describe the accident or occurrence that caused injurtlamage. (Give full details upon which you base your claim. If a City employee was involved, give the employee's name.) j /`7" v 4i'N l 4 a fc/ 7 144 . j 974--2 - r L ! c/S 4 iY470 g G/ / . N '4'v f, sz.. (/,O 'N 4A-) o 4? ve) , 4-A c3i1/ L r %- / / .- c. J �u tie_ �� /Ca.— ec / T / /J LA-1 t u 1 u TG yJi .�✓ // Y 4),A...) �,e f7 7 o . :j / - /1J 4 jU/ .-7 © U.A. F /,,.� 1C fie a �c/z ©/Pe- — O 17 4 7 4., 8. What were weather c• •ditions �. � ,� / / / 2 AO 44 d 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). J 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.) J 07 Z-1.)€.;"7.- ' f / 7 7/e H'/ 6Q'f--fil Gf A o - LCJG .e r/ 4 iial q // 1-44. Litt 0/Z Pi s.'r71., 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.) 151What amount do you cl .3 cs -) c from the City of Dubuque? 16. Why do you claim the City of Dubuque is responsible? G 1 s ! /Co /..) 7 4 A l ¢ 4 4 Ciff 1" f � � e ..) 411,J c.6{U t ( .) 7 FiP 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? (Print Name) ,20 /d. CY c �Tl rm 0 igna • re) , 'zy ( ----);:///C ‘e "F CD 0 a al o o to 3000 Carter road CARPET FOR THE FOLLOWING ROOM lO X 15 12 X 15 WITH CLOSET 10 X 17 WITH CLOSET 12 X 36 WITH CLOSET BATH 8 X 8 VINYL FLOORING 12 SHEETS OF DRYWALL REMOVE AND REINSTALL, MUD TAPE AND PAINT WOOD TRIM 350 LINEAR FEET Door frame 3 INTERIOR DOORS Not asking for removal of carpet, doors, furniture and misc. items or disposal. Do have pictures.