Claim Bublitz, LoisCLAIM 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: Lois M. Bublitz
2. Address: 2480 Mineral St., Dubuque, IA 52001
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3. Telephone Number: 563 583 3308
4. Date of Incident: January 23, 2005
5. Time of Incident: Approximately 10:00 A.M.
6. Location of Incident (Be specific): On West Street in front of 2367 West Street.
Water flooded to property at 2480 Mineral.
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.)
City Water main break - flooding yards and basements of three homes in the area.
The Water was not turned off for 3-4 hours.
8. What were weather conditions like? Weather was cold, sunny and below freezing.
9. Give name and address of any witnesses: Mike Brekke, City Water Distribution Supervisor and 20 members of
my family.
10. Did police investigate? (If so, give names of officers.)
Police blocked the street, but none were at this residence.
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No one was injured.
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.)
Water flooded the property and basement of 2480 Mineral. The pressure and weight of the
water in the yard caussed my basement wall to crack and bulge. All sidewalks and the patio were cracked,
sinking and leaning. The yard around sidewalk and steps was washed out.
13. What other damages do you claim, if any?
Kenmore dryer was flooded with water and mud. The window well filled with water and
came in the dryer vent pipe. The wooden privacy fence in the back yard was damaged.
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.)
The claim was denied by my insurance company saying this was a "flooding" incident at the fault of the
city.
15. What amount do you claim from the City of Dubuque? $16,994.20 (Kluck - wall); Dryer $400.00; Fence $725.00; Total $18,119.20 Air conditioner?
16. Why do you claim the City of Dubuque is responsible? The water main belongs to the City and the
length of time it took to shut off the ater.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) Only my insurance company which denied the claim.
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 day of , 20 .
/s/ Lois M. Bublitz
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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CLAIM AGAINST THE CITY OF DUBUaUEj'IOWA' Dt3
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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: lvo; s m ' G lAb I;t 2..
2. Address: d4r?o fnitHrQ/:Sf, I Mv..bu'OlA.l IA fJdODI
3. Telephone Number: 6G..~ - s?ra -- ,~30 ~
4. Date of Incident: JCtw'\LlQ ('j ;)3 , ;;JooJj
5. Time of Incident: APP(,Oi-.\MClte0 JD:OO Am.
6. Location of Incident (Be specific): Dr. IJ.t.s+ 5+r..e.d In tro,,"+ of ;},3(,'7 lL).ls+-
S\'w-t \,,)o..h{~IO()d,d tD p(Dp~r~ ~:f .;t'l'JO !YI,I'I unJ
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.)
C':,'tj \)..~oJ-t1i' MOd t'\ b(']/(\I( - EJ oor9n:\j ;p_n:l.s o.n&
-t-V\(U V\IWV\~~ \V\. -I-ka.. <,\,"""0... '-n'\/L ~'hkr WCLS rlO+
\01 3i-o Y- nOLc"S
b(l;)Q Muds of
+/-LV'MCP off
8. What were weather conditions like? uJea.ff.J.., was cold; .<)1.1 rlV\;j Clnd b9Io(;:,tr.Rf<:;~,
9. Give name and address of any witnesses: rYli K\: BrQ \<.1< t I c.,f:j t,c.\:d,ty ~istf'b" t;'oVJ
S,..p.>..'(v~::,cr (tl"\c\ 10 VV\-"Wlb!tv,') of f'YI':jtal'Y\,lj'
10. Did police investigate? (If so, give names of officers.)
.Qo\l~.e.. Ioli)tKed +\A.I.. S'kl!.Lt, 10....+ none ,.0er~ cd +hi.s re:>,dRV\('e,
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No Ol-\€- W(lS ''\jvJ..J ,
l-tl
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.)
,
,
.
.
\1~OJt, ,\;:\ood.t.d -+~ P(,oD~'~ (t\'\d ba.~~V\+ cd ;)t.J'ifO (Vl,,,uo,/.. in.e.. ".
\l'fiS;,\J.vtL Ccn.d b$l<jht- ~. W woJtr 1(\ '~ jcl'l'oI CCluS-(cl m:j bct~~~l'\.+ uXt/J Jo
(\ vCl.t!\i.. o.l'\d 10""'9(1,. All s',dl'uJl\.IK~ ()..V\d +~ poJio i.(.IU.tL. emelU.d, -;;1'\1<.,',,-') "-nci leM,'rt;}
'II-It. ~o.rd Cd'OU.MI 5; dtwc..ll.... CJlLI s '-"fl~ w(t:) wCt:>h. d cu+.
13. What other damages do you claim, if any? my Ke",fl'Io."e.. dr:Yir l.lJtl5 flooded
lkl\\ch. ~o..4f Cl.i\d MlAd. ,he W;t'\&O'k\ wQllL /I~& liJi+h l./)cLkv CtV\& MM~ in. fh.e dry!'"
Vt~ ~\fl~' Il'u. woo(is.", ~,\"c..~~\'L"t.L IV\. '~ bQ~1<.. yard W'1.5 do..''V\4.1.ed.
14. Have you been compensated for any part or all of your claim by any insurance
company? (If so, give name and address of insurance company and amount paid.)
'1'1-\'2- dO-1M wC\.S d~n.'Uld bj' ("t\'j '\t1~",-n'\.l'\~ll eOMpo.nj 5QtJi':J -/-hi.5J uJtl.S
Cl "~lcnd\r'\3" 'I M, dud- 0:+ +he '~cLlAI+ of+~ (!i'~j'
15. What amount do you claim from the City of Dubuque? 'P / f,,, 9 r if" _.~ (") - KI'll'/( (1I-1Cl10
t0r'flR. -'Lf()('),c~ I F..neQ..,l1J5,Ct' TdaJ -$ 15',,11'1,.10 l'JirUlnJ,+;'ofllIZ7
16. Why do you claim the City of Dubuque is responsible? -rl-1e ~o..+e r \')'\0-.11'\
b~ IOl'\qS
v
_+0 {~ C.'It1 uncl +N. le.flSth ot {'Me.. ,{too\<. to Sku.-I- oH-
-l-M wo.:4y-.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
OY\~ Mj 'lV\~vXRJ\e Q. e.oW\pa."j, whd'\ rlH\,td +\.u. (dc.."M.
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
day of
,20_.
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loiS M, BlA.br,tz..
(Print Name)
(Rev. 1/00 & 7/01)
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:KLUCK CONSTRUCTION
P,O, Box 1045
Dubuque, Iowa 52004-1045
Phone: (563) 556-2284
Fax: (563) 556-2285
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Page No,
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PROPOSAL SUBMITTED TO PHONE DATE
Lois Bublitz 583 3308 ?..ILn<;
STREET JOB NAME
2180 Mineral
CITY, STATE AND ZIP CODe JOB LOCATION
Dubuque, Iowa 52001
ARCHITECT DATE OF PLANS JOB PHONE
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
We propose to remove and replace 480 Sq.Ft. of 8" block
foundation wall. This project will consist of ecavation around
the perimeter, remove and replace patio, front, back and side
sidewalks. Front steps, front sidewalk parallel to street. Try
to raise front stoop and stabalize. Lay new reinforced 8" block
wall, drain tile, and tar foundation, shoring of floor joist,
landscaping.
$16,994.20
WE PROPOSE hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
dollars ($
),
PAYMENT TO BE MADE AS FOLLOWS:
OTE: THIS PROPOSAL M
WITHDRAWN BY US IF NOT ACCEPTED WITHIN
AU material is guaranteed to he as specified. All work to be completed in a workmanlike
manner according to standard practices. An)' alterations or de,"'iation from above specifi-
cations involvin~ extra eoslo; will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessar)' insurance.
Our workers are fully covered by Workmen's Compensation Insurance.
AU,"ORI~;n
SIGNATU
DAYS.
ACCEPTANCE OF PROPOSAL - The above prices, specifica-
tions and conditions arc satisfactory and are hereby accepted. You
are authorized to do the work as specified. Payment will be made as
outlined above.
SIGNATURE
DATE OF ACCEPTANCE
SIGNATURE
NOTICE: If any unusual or abnormal soil conditions such as rock, rock ledge, quicksand, large boulders, loose fill, springs or
water are found when excavating, then the owner must be notified in writing or verbally of the existing conditions, Any labor or
expense necessary to correct these conditions must be considered EXTRA WORK items and be paidjor by the owner.
TERMS: NET CASH 1-1/2% per month finance charge on past due accounts over 30 days, plus any and all collection fees,