Claim Hallahan, Robert CLAIM AGAINST THE CITY OF DUBUQUE;4OWA '
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 SL, Dubuque, IA 52001.
It will than ha referred by tha 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 crrY 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:. Robert Hallahan
2. Addraes:. 2145 Key Way, Dubuque IA 52002
3. Telephone Number: 582-0643
4. Date of Incident: November 18th, 2003
5. Time of Incident:. 6:15 PM
6. Location of Incident (Be specific):. 2145 Key Way
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you base your claim. If a City employee wes Involved, give tha
employee's name.)Somtime dudng the day of the 18th the city sewer truck jetted the line
along Key Way. At 6:15 PM we discovered sewer water backing up in outrbasement.
We called the Police Dispather and asked for someone to come up and help, because
we thought the line was plugged out in the street. No one came. The 19th we called the
street department; A crew came and checked the city line and said it was clear, they jetted
it again. Our line remained plugged. They suggested we call Roto-Rooter.
8. What were weather conditions like? N/A
9. Give name and address of any witnesses: N/A
10. Did police investigate? (If so, give names of officers.) No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
12. Was any damage done to property? .(If so, describe property and the extent of ~lamages.
Attach estimates of damages or describe basis for ascertaining extent of damage.)
We had to call Roto-Rooter to unplug our ,lie. The workmen messured the stopage at
51 feet, right were our line dumps into the city sewer. They pulled back some sludge and
lime. The said it was pushed up our line when the city crew ran the jet down their line.
The bill was $182.97 we feel the city was responsible for the blockage and should pay
to clear the problem. The crew could have fixed it when they came out the second time.
13. What Qther damages do you claim, if any?
No
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
15. What amount do you claim from the City of Dubuque? $182.97
16. Why do you claim the City of Dubuque la responsibla?.
If they hadn't jetted the line improperly, we would not have been plugged.
17. Have YOu made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) No
18o if the answer to Question 17 is yes, have you received any payment from that soume,
and if so, in what amount?
Dated at Dubuque, Iowa this 21st day of November ,2O 03
~'~ ~ Robert Hallahan
*-~ ~ ~*~ ~ (Print Name)
(Rev. 1JO0 & 7/01)