Claim Felderman, William
CLAIM 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 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 YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1.Name of Claimant: William Felderman
2. Address: 2180 St Celia, DBQ 52002
`
3. Telephone Number: 563 583 5561 (w) 563 213 2222 (cell)
4. Date of Incident: Sun May 23, 2004
5. Time of Incident: Overnight
6. Location of Incident (Be specific): In basement (finished area & unfinished area)
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.)
Due to too much rain, City Storm drain backed up into basement - sewer back up
8. What were weather conditions like?
Rainy
9. Give name and address of any witnesses:
Tommy Kann - Kanndo Professional Services 950 Main St. Dubuque, IA 52001
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 damages. Attach estimates of damages or describe basis for ascertaining extent of damage.)
Carpet damaged, drywall, bathroom vanity & a bar cabinet trim on drywall floor.
13. What other damages do you claim, if any?
I am owner so renters will claim their stuff.
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?
$4303.47 per estimate
16. Why do you claim the City of Dubuque is responsible?
When the sewer people came out told us (me & renters) that it was there fault.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
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 2nd day of June, 2004. .
/s/ William Felderman
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
(JC!!.' ~c/
.' èLAIM AGAINST THE CITY OF DUBUQUE,IOW~:1::L{j ~¿tt/
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 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
YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: N ì) \ ì c. rY' f£ I D £(LyY)"~
2. Address: Z I ~o &\--' <2.é' I ì Ov D 'Eo 5 zoo 2-
3. Telephone Number: 5LD3- 5<63. '5SLO Cv::» Si.o3. dI3.8é78i31 (ceL.t)
4. Date of Incident: ,,')u V\ 't--Âo.,/ Wrc\ "2()()L}
5. Time of Incident: 6'\1-e.VV\\<Õì-.-J,;-
6. Location of Incident (Be specific): \Ñ
+ \ÀV\-\1V\ìsY\ecL C1l1eCÁ. ')
bOS-emCA+ (+1 V'\ \"5h"ecf Q vea
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.)
Du.'è. ïo L"" fv\\,lc.h "\:..0\\\'"'1, C\t'-{ ~\-o"'1"r"'- c),.-C<.'tYî
bo.cveol, t.-Lf IV\+O t:>o¡<::-f'.vY17"...V\-+' Ç'Æv-.r1Ztt' \i::-f<- tAt?
8. What were weather conditions like? ~('¡ i 'fI.,¡
I
9. Give name and address of any witnesses: I ONtJ\'{ \Lf\'Nt--J - '? Pr>J~ 'þ D
rl('~e.SGìDVlO\\ Sevuìces QSo lvlal'I'ì.s--\- "1)13,& s-z.cvl
10. Did police investigate? (If so, give names of officers.)
NO
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
~a
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 (ì V'Vfi- C\OI V'n Ct ~-e ci- Î c\""'lINCA. \j I 'ß<",.~,o=~ 'fC{ '(\\{.-'I '\- 0\.
\:::x:zv CO\.biV\-t:..1-, \vìV'V' ...,...--, d..--yw«',,\1 -f-IDO.r.
13. What other damages do you claim, if any? \ C?< l'Y'\ 0 u.:>h,e ¡.-, .:s 0
lÅj; \ \ (',\a ¡ yý\ -\-\'\N(. ~-\1A4 '
fe\'\~~
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.)
"-\t)
15. What amount do you claim from the City of Dubuque? 1/ ¿j '303. '/1- 'F*-if E sr.rv11#T£.
16. Why do you claim the City of Dubuque is responsible? \N'X\-eY"'\ +\rê:. SeIDe,
y(J!\"Y'q, ~()'N\.Q 6lA-r- -'role\ iA'? C '(VI-e:..... -\- rcl"-tc.v-s) +hc..-t'-- H-
\\\C\~ ,,"\f.\rf-/ ~\A.\-\- ,
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, givename 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
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Box 3218. 10426 Stonewood Dr. . Dubuque, IA 52003 . (563) 582-4976 . Fax (563) 582-1727
June 2. 2004
¡k 2180 St. Ceho
Altn: lJilll'ek1cnnau
Propusa1: Remove old carpet and pad, furnish a.nd Wla!! new .o!pOt and pad due to w..,r dOInilgo:
To",¡ bid tax includc:ù: 90 <-y-@524.:57..y.=$2,211.30
Nole: Bid b..'iCd on site visit mea,ur<:mc-nt,
Thank you
Commcr<:iaJ Flooring Co.
Mike Dennett
E.timator
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Commercial Carpet. Sheet Vinyl. Cerami;;Tile
, Adam's~
111
Iowa - WISCOnsin - DIinois
"from smaIl repairs to new construction"
Free Estimates - Quality Work
Service
CUSTJJMER
Name I:SILL >ré:U>
Address &1 to .6+.
City DvsuG.>vE"
Phone ..5~ $Eß5S~ I
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State .:l<1 Zip .6zOQ'è
DESCRIPTION
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Sales / Use Tax (if applicable)
Subtotal
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Total
Adam Felderman
Contractor
563-599-6600
P.O.Bo~ 1813
Dubuque. IA 52004.1813
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TOTAL
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Unless otherwise specified in writing:
1. Both parties have read, understand and agree to the prices and job description herein,
2, Acceptance is limited to said description.
3. Any adclitions or deletions to the said description will change the pricing of this aggreement.
Accepted by:
Company:
I, J. .
.Á' . - (563)556-6168
~I J 1-800-556-6168
~ Fax: (563) 556-4680
~.",.Jfl emdl: km.mdo,n;dbq400I.wm
"~o>"e www.<onndo.wm
950 MAIN STREET - DUBUQUE, IA 52001
CARPET CLEANING
Room SI,. Sq. Ft Amoo",
KITCHEN
D[NING
LIVING
HALL i
STEPS
BEDROOM
BEDROOM
BEDROOM
BEDROOM
FA,!~ f--
BASEMENT
,
0 Vacuum to lemove embedded soil flOm cacpet flbelS
0 App[y ple,splay and deodollzel to loosen dIrt flam fibel
0 Steam clean w/RX20 IOta", steam exllactol
0 GlOom cacpets to set pile foe effIcient and unifolm appealance
0 Heat Tlansfel
0 Treat spots as needed
0 Move and block up fumllule as needed
0 Carpet ians leff
CARPET CLEANING
CARPET PROTECTOR
CARPET CLEANING & PROTECTOR TOTAL
UPHOLSTERY CLEANING
PIECE DESCRIPTION AMOUNT
I
I
UPHOLSTERY CLEANING
FABRIC PROTECTOR
CLEAN[NG UPHOLSTERY & PROTECTOR TOTAL~
AIR DUCT CLEANING
0 Remove leglstels and hand wIpe
0 Ail wash all ductwolk
0 Wipe down interiol & extellor at furnace
0 Re.lnstall legIst'¥'
- -
WATER HEATER
DRYER VENT TOTAl
AIR DUCT CLEANING TOTAL
ENVIROCON TOTAL
AIR DUCT & ENVIROCON TOTAl
IOj~I"'.."'J'J~
Client Name 8,/// H/r/€A?M.441
Addle"" ,
CIty f)ßé1.. 9--~~~ I
Job Addle"' 'd-IRc;.sf- eel 1/4 '
Contact
Job Phone< Ou", Phoce
E.maIiAddl"s. My ..5)?C¡-O71?2 -----
Cleaning Date<
Phone Book,
Esllmate,
Yellow-
8[aok-
0 Cash 0 MastelCacd
0 Check 0 VISA
Expll"-
To.',moo",'ooopocoomp"liocol"nices.Alio'""""9'olt.S%whlahi,'0
,"ooelp""""ge""olt8%,wlllbeah"ge'oo,"e,mooolol'""",'ol""'rtlog30
doy,eft",",'o,ol""'e.
OTHER
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KANNDO Plofesslonal S",I", wacte to "~e you beO". Plea" lead the
lollowlog "n"m" awalen"s ;nfOlmatloo and ;nitlal it.
When w" the '"t "me yo", "Ipet w" aleaned?
How was it cleoned?
AI'" technIcIans of IIoe" spitls beoaoso we may h"e to ose a ploeess
to plmnt wlc",ng,
Cacpet Cleonlng
PI"" move smalillems, kolak knaaks, an'oe", bl"kabl", etc.
FOIldeal d'ylng conditions set yoar thecoostet at 72', 0" ',os aod
dehemldl"elS, "p'clally In basemeote.
PI"" '"ve blocks 01 plastic shaats und" lum',",e fOl 24 hculS 01 until dfy.
The KANNDO method of cleaning cacpate will deod"l" & saniti"
youI"""t
We cannot lepailwom fibelS thlOogh ""nlng.
CI"nlngwlll not"pallcol"",s due to fading, cham'cal damage, pet staIns
"any oth" pecoanent stalns 01 "'01 changas doe to SHT, and I "
folelgn materials embaddedin eafpet that may wick op and coosa fed,
blce, gl"n, yellow, ,tc. spote.
UpholstelY CI"nlng
Dce to the unpledlctable na"'e of upholstefy fab,l" and dy", KANNDO
makes no "p,esentatlons °' wallantles "gacdlng the upholst"y
cleonlng to be perio,mad,
Take caution when comIng off of wet calpet to hald sortac"..
sllppefywhan wet
8y Initialing wh", Indlcatad below, the client acknowledges that
client "sum" all risk assocIated with the cleanthg and heleby
let"s,s KANNDO from any and all fo"" damage, 01 "pen" sostained
by client as a lesult of the cleanIng.
Payment doe epon compl'tlon of the job. THANK YOU'
I have I"d and uodelStand the abov' and have le<"lood comollmentafy
Avenge",d SpoolngChartO
Th",k yoo fo, ""Ing KANNDO P,ofesslonal S"vlces!!!
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