Claim Sabers, John - Jack CLAIM AGAINST THE CITY OF DUBUQUE IOWA 'i-
is written report constitutes your claim against the City of Dubuque, uld
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
2,
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
Name of Claimant: ,~./~- ~ /v~ ~-5, ~o ~. (~/,~4X') ~.~_~>
Address: ~ ? ~ p~ ~ ~ D~,
1
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.)
? /
8, What were weather conditions like? C / o ~- ~ V wa ~ w a. 3.~ v
[ /
9. Give name and address of any wl'tnesses.'
10. Did police investigate? (If so, give names of officers.)
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? /~,~-~/~4~
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 Dubuque? ~
16. Why do you clmm the City of Dubuque is responsible? t~
17. Have you made any claim against anyone else for damages as a result of this incident?
(11 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 at Dubuque, Iowa this
(Rev. 1/00 & 7/01)
day of
(Print Name)
(563) 556-6168
1-800-556-6168
Fax: (563) 556-4680
emaih kanndoincdbq@aol.com
website: www. kanndo.com
950 MAIN STREET - DUBUQUE, IA 52001
CARPET CLEANING
Room Size
KITCHEN
DINING
LIVING
HALL
STEPS
BEDROOM
Amount
Client Name: ~0~. /~]
Ci[y /~J~(~. ' Stat e ~7'/'~-
Job Address
Contact:
Job Phone' -..~ ~ -~--IU~.~ Other Phone:
E-mail Address: /
Cleaning Date: / Estimate:
Phons Book: Yellow Black
j~J Cash j~ MasterCard #
~ Check ~ ViSA Expires
Total amount due upon completion of se~ices. A finance charge of 1.5% which is an
annual percentage rate of 18%, will be cha~ed on the amount of this invoice sta~ing 30
da~ after the invoice date.
OTHER
--AMILY
BASEMENT
'~ Vacuum to remove embedded soil from carpet fibers
A
pply pre-spray and deodorizer to loosen dirt from fiber
Steam clean w/RX20 rotary steam extractor
[] Groom carpets to set pile for efficient and uniform appearance
[] Heat Transfer
~ Treat spots as needed
[] Move end block up furniture as needed
[] Carpet fans left
CARPET CLEANING
CARPET CLEANING & PROTECTOR TOTAL
PIECE DESCRIPTION AMOUNT
UPHOLSTERY CLEANING
FABRIC PROTECTOR
CLEANING UPHOLSTERY & PROTECTOR TOTAL
AIR DUCT CLEANING
[] Remove registers and hand wipe
[] Air wash all ductwork
,[] Wipe down interior & exterior of furnace
[] Re-install registers
WATER HEATER
DRYER VENT TOTAl
AIR DUCT CLEANING TOTAL
ENVIROCON TOTAL
AIR DUCT & ENVIROCON TOTAl
KANNDO Professional Services wants to salve you better. Please read the
following consumer awareness information and initial it.
When was the last rims your carpet was cleaned?
~s of liquid spills because we may have to use a process
to prevent wicking,
Carpet Cleaning
Please move small items, knick knacks, antiques, breakables, etc.
For ideal drying conditions: set your thermostat at 72', use fans and
dehumidifiers, especially in basements.
Please leave blocks or plastic sheets under furniture for 24 hours or until dry.
The KANNDO method of cleaning carpets will deodorize & sanitize
your carpet.
We cannot repair worn fibers through cleaning.
Cleaning will not repair color loss due to fading, chemical damage, pet stains
or any other permanent stains or color changes due to BHT, and / or
foreign materials embedded in carpet that may wick up and cause red,
blue, green, yellow, etc. spots.
Upholstery Cleaning
Due to the unpredictable nature of upholstery fabdcs and dyes, KANNDO
makes no representations or warranties regarding the upholstery
cleaning to be performed,
Take caution when coming off of wet carpet to hard surfaces... slippery when wet.
By initialing where indicated below, the client acknowledges that
client assumes all risk associated with the cleaning and hereby
releases KANNDO from any and ail loss, damage, or expense sustained
by client as a result of the cleaning.
Payment due upon completion of the job. THANK YOU!
I have read and understand the above and have received complimentary
Avenge and Spotting Chart []
Thank you for calling KANNDO Professional Services!i!
SUB TOTAl
TAX
GRAND TOTAl
100. Guarantee
FRANK HA55EL & SON
Plastering and Lathing Contractors
BOX 536, DUBUQUE, IA 52004-0536
Darrell 582-6972
Jeff 556.0532
In Acconnt With
Jack Sabers
3589 Keymeer
Dubuque, Iowa 52002
Closing Date -Nov. 28, 2003
Labor for removing furniture in the basement
on Nov. 4, 2003.
Total Labor ..... 7 hrs.
Total Amount Due ......... .$175.00
due to flooding
Terms:
PAYMENT DUE UPON RECEIPT OFTHIS INVOICE
Service Charge 1 1/2% per month added after 30 days (18% annual)
(MINIMUM CHARGE $1.00)
TOTAL ~.~l~), ~0
o~O~iT ~"~ ~. 0 0
BALANCE DUE
CARPET OUTLE~ ~
B~I O~l Flaring Wldl~ L~I~ ~-Y~I~ 80-~Dl~ AMOUNT
& AY FR M
P 0 su~-~o~
Oash & Carry policy ellm,nates' ~0.~ 0
We operate in t,his ~anner~ s~
- that the sawn~s may be
~ passed ~ ong to you by offer4
ing consistently Iow pric~s.
TERMs:THE OI0 THE CONDITIONS OF THIS 6ONT,ACT,._:) ~r delivery.AND ^CKNOW!~EDG~S~ ,. /I""-RF'qEIPT'' OF ^ ~COPY'OF ~T D^~-En^~D ,,CO"""ET~ ugh:
" '~ ' ~ Thank
Custo~r Signature ~ , ~ - -,.; ]~,,,
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