Claim, Kieffer, KenCLAIM 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: Ken Kieffer
2. Address: 1577 Geraldine Dr. Dubuque, IA 52003
`
3. Telephone Number: 563 582 1684
4. Date of Incident: December 16, 2004
5. Time of Incident: Approx. 11:00 a.m. when I noticed water in basement
6. Location of Incident (Be specific):
1577 Geraldine Dr. - residence of Ken & Kris Kieffer
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.)
The sanitary sewer line to our home was clogged so we called Roto Rooter and they had to open the
manhole to see why they could not clear the pipe. They called the City and Tim Lattner and
Russ of the City came and Tim went into the manhole and brought up concrete from the manhole
shaped like the pipe.
8. What were weather conditions like? Warm in the 30's.
9. Give name and address of any witnesses: Daryl & Steve from Roto Rooter
Paul Herrig Plumbing Inc. 563 552 182?
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.)
Basement floor drain backed up causing us to have Roto Rooter come to unclog
the main line which was obstructed by concrete in the manhole in front of our
sewer line.
13. What other damages do you claim, if any? $287.83 for the Roto Rooter bill and nothing for
the cleanup we did ourselves.
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?
$287.83 for the Roto Rooter bill.
16. Why do you claim the City of Dubuque is responsible?
Because the concrete that blocked our sewer line would have been put there by the City.
The City sewer dept. came back and removed more concrete from the manhole the
same day to prevent any further blockage.
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 6th day of February, 2006 ?? (s/b 2005!!)
/s/ Ken Kieffer. .
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
7/ . /!/ fl /'/
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This written report constitutes your claim against the City of Dubuque, Iowa. You sllould
complete this form in full and attach any additional information that supports your claim.
.
.
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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.
:: ::::::,clalm;;7*~Ge:1j: Dr. _
3. Telephone Number: Sb:3 5?:J. - /6't'j
(Pc..ew.ber / j;1J. dc>otj
5. Time of Incident: Afpmx. / / :O() tN1'\. wkn / fldlCed lIJI1-kr IfI bo.SeYtleJ,
6. Location of Incident (Be specific): /57 7 6ehJd I y\'e n", . re.s(r/,oW' {:
of Kefl ~ -Krt'5 ~pJt;r
4. Date of Incident:
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.) A1"..L / . - ,~~~ J
//II.e- MhlTCI.(j $~r m.e -to ClAY' AOWlC Ulfl~ d6j~
~o We. ca-l/eJ ~crt2> <t?oJ~ ~ had +0 opa. ~ hole.-}o see. tA}"-~~~
CDu,1cl. l\oI-' c1eu..r +ke \ e... lite C4lleJ -the c..i-t CUltX IIi+. LiL-fb.er h fv.&5
. ~'^e. c.lt~ c.a.we. aVl.li,,1V\ we. . I'~ 0 e. muvlhole.-L\ b"6...+ ""p CO;1Cre..--re.. fN>l""-
8. What were weather conditions like? -+~. +ke.. hI> >:oll ;kc
8\ -t-he.. pip G- .
9. Give name and address of any witnesses:
[b:f!j\ '" Seve...- ~OYY\ ~"rta 'lZod--b- /fp,lJ.1 +1e.rriS PIl.l~i~5 Iw:. 5'63-SS")-}8JC
CJ
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
(1.)0
12. Was any damage done to property? (If so, describe property and the extent of d~mage~.
Attach estimates of damages or describe basis for ascertaining extent of damage.)
BQ.EeiY\€..~-+ floOf' clfOc~V'. bc.-kA Up CD.-lA.S1V\5 v...{:, +0 hCI..Ve-
_ftcA..o ~ come- +D UV\ d(~ 1-hP_ VY\D..~'" I )~f'_ l.AJ~\J\, L\JD--S 6b-h-"lAdJ
~!} C-DV\(1.fd-~ I~ *F_ WI(A\\.ho\~ ll/\ t-ro\'l.+ C\- OlA)," sevJtlr I VnD ,
13. What other damages do you claim, if any? rJ ex ~ 7 , 'b 3 for- -+h e.. Rotc
Rooter ,l)i I \ {{!IV;! I'lJh~) fo~ the.. deaV\lAf /,l)e d,J OlA-f ~[\}e~ ,
,
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.
tcx~7. ~3 Yo/" +h~
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
, 20..f.lh.
Dated at Dubuque, Iowa this
'-fA
o day of
tc-
(Rev. 1/00 & 7/01)
Locally Owned and Operated
PAUL HERRIG
PLUMBING, INC.
RDTD-
rRO!!':~.
_ SEIIVICE
" And AN'lIf CJo 'ltou6les 'ZIoNn the 'ZIMin " "
P.O. Box 1533' Dubuque, Iowa 52004. Phone 563-552-1828
. TV Camera Inspection & Video Recording
. High Pressure Water Sewer Cleaning' Electric Sewer Cieaning
CUSTOMER'S
ORDER NO.
NAME H fn /-1'iqF.: n
I ~
/ 1....,-
DATE ,~ ...)20
<->1
ADDRESS
/..~ 77
,s-'S' .'1- !?4 ~.. ~
6rtJlI(~r"'<: ~'~<"<~J
TOTAL FOOTAGE CLEANED: KNIVES USED
JOBDESCRIPTION~NDREMARKS:.C i 1:A-n~ ,\"... ""~\~ \~."'~
pr<>M.ct>.J..rP-o ~oblt.I","(,{TI';."" \"-\0"'-.1....."
m~nh.:-i i. w'.\\..... I h'L cC'.bl1.. Pi.? ,f7 C:!JJVV'..1\t..ol1. "'-<',oJ d
1}lIe;,Lo<,I{I';ll\t\",-~")i. ~\1-u"IA'~ a.~\"a'>n'~~ $. c
'TM, I'lT'if'4.\ l-"W~' C"t\\lf~l\.... ,,',1:1 b~Yl---:.I,~ TOTAL:l~ 7 ~3
. ,-,p'T:-h'l w,.u-L"Tj...< I'N'thh.d2. Cl"~ c<,\C'<\!~,uPI..EASEPAYFID.11HS~. . J
C~~'i.. 'o..t91..P-'::;~"'" c-'f'....~~o!:."I~i.'" \.l~t ~~mtrtr,"",'n...rv..('I'\n1'~
V.I< CU:OMERSIGNATURE OPEjAio~N::;z.:JI :<,.,",)\'~1y'lU(,.ok
{(~'llrt~ 'n-)(I"lI'tl."jt:6~ T6 R~ lV\.C....:.t'\l.c; I::?<~""'~";\';
A service charge of 1 1/2% per month (18% per annum) will be charged to all accounts past
30 days. Costs plus reasonable attorney fees to be added in case of suit for collection.
HERE'S THE PROBLEM I FOUND AND FIXED.
YOUR: WAS CLOGGED BY:
o sink 0 grease
o tub or shower 0 food
o toilet 0 paper or sanitary products
o laundry / washer lines 0 hair
o fioor drain 0 lint
o septic tank line 0 tree roots
~sewerline ~ign objects
o other 0 sludge
o soap residue
o other
CHARGES
sink................... ..................$
tub.......................................$
toilet....................................$
floor drain..................... .......$
laundry ................................ $
septic line ............................ $
JO/)
J/,-. .-
?{ ....::>
/ " :AJ..
main sewer.K....................$
71,~"" $
$
$
$
',/..,,- ',;T>t fc.. \ r,... 't. GO'S ", -(To '\I.'\' 111 "'-l'Ih",I'i...