Claim Freedom Properties_Jeff SheetsCLAIM 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: Freedom Properties LLC Jeff Sheets
2. Address: 3500 Dodge #101, Dubuque IA 52003
`
3. Telephone Number: Home 556 7863 cell 590 1000
4. Date of Incident: Summer of 2004
5. Time of Incident:
6. Location of Incident (Be specific): 631-633 Chestnut St.
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.)
When Chestnut Street was rebuilt, my sewer line was not hooked up. Todd Irwin,
City Engineer, can verify this. My sewer line was plugged and had sewage
backed up in my basement.
8. What were weather conditions like?
9. Give name and address of any witnesses: Todd Irwin, Fondell Excavating,
Roto Rooter, Complete property maintenance.
10. Did police investigate? (If so, give names of officers.)
No - City Engineering did.
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.)
Raw sewage backed up in basement. Had line snaked twice and camera ran down it. Also had Serv Pro clean up.
13. What other damages do you claim, if any?
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? $1683.20; Complete Prop. Maint. $85.00;
Roto-Rooter - $1180.21; Serv Pro $417.99
16. Why do you claim the City of Dubuque is responsible?
The City of Dubuque decided to rebuilt Chestnut Street and hired the people to do it.
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 15th day of February, 2005. , 20 .
/s/ Freedom Properties
Jeff Sheets
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
cc'- 11' {;1f'1
biJ'1
CLAIM AGAINST THE CITY OF DUBUQUE;'IOWA ~ 'I~
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: H€R#fJ..... froozer..J.,'es LL. C <Tet t Sh.ewf.s.
2. Address: '31700 000/ -if:: ID / ,I OVbu~v-e-, -:z=ft. ~~Do3
3. Telephone Number: Ho""L : C;S&> -, <:((.,,:, Wtc;'''IO'IDOO
4. Date of Incident: SUM ~r ot '2-00'--(
5. Time of Incident:
6. Location of Incident (Be specific): (p 3 j - & 3> 3 c4t-S+h v {- s. tr~+
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.) w.'/ . /J / / f. .. _ L r 'j /
f'l.f:/f1 kltf.. 5 rr f1 t/ S f-fl.e(0 W c:. <; (' e- J::> 1/, '/; /1,.. y
I I (
S~r (('V\~ GJt;S 1'\0 f- t)Ool(~ VI. 7OcLJ... Trw/'l.
t/I-". ~tJ;I(.-eer (!u.", Va,';; J'h,'J. /lI/j '7~v-er /':1/ [N?<> tJ/tlrfq~
/ 011 d ACt rL SewClIJL. h4 d.4/ t/;? ,'/1 J11 '1 tM ~T.
8. What were weather conditions like?
9. Give name and address of any witnesses: -(l; <il :Erwiil,' 1i>/1c!e./1 8,K("it/?ihqj i
tc~ Kookr/ r!tJ~/g./.e. (Jo.ft(/-.'f J11a,~ k../i~c..L . .
10. Did police investiga~eJ)lf so, gi~e .~amesI?~f of:'icers.~ d,. d.
/ v u - ~I 1'"1.( f/./YI 1//1 ~.r- ^)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
;Uo
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.) .
kCuJ ~CitY tc(~ vI' /1'/ bC1~r. !lac!. l~
Silt<. hd -hut'CR.- 1- C~W\o,r~ r()..f'\. bNII /1-- /1/>0 Ac. cL
S.ertt f>ro C/~CU1 vf.
13. What other damages do you claim, if any?
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.)
/Vo
/l,0C,
16. Why do you claim the City of Dubuque is responsible?
-1h- () '/-y (}l f)(/tt/~ dec.,'W It; (e bvJI ~~h,l/r <;Ir~
~c!. h ,'{'d Ik f.t~!e.. 10 cb ,. i-;
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) /1/0
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
~ IL
Dated at Dubuque, Iowa this - It? day of
RptC/Cv'l ,20 lJ5-.
/1,1; ~ F=b, ~LI'" ~-I-if.sLl.-l
/~I(Signature)
-:rePl- S,h.-e.M 5
(Print Name)
. ..-"..
,)()
(Rev. 1/00 & 7/(1)'" ~
. RIITII-
rlt~l!'.
_ SE..,CE
. And A"'tl'( 00 'lAoubks ~"'n the ~ttin . "
P.O. Box 1533. Dubuque, Iowa 52004. Phone 563-552-1828
Loca.lJy Owned and Operated
PAUL HERRIG
PLUMBING, INC.
. TV Camera Inspection & Video Recording
. High Pressure Water Sewer Cleaning. Electric Sewer Cleanin!J
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CUSTOMER'S
ORDEF\ NO.
Fu s:d ('", \'1\
NAME
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ADDRESS
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HERE'S !HE PROBlEM I FOUND m> AXED.
YOUR: WAS CLOGGED BY:
o sink 0 grease
o tub or shower 0 food
o toil.t a paper or sanitary produds
o laundry I washer lines 0 hair
o floor drain 0 &0\
o seplic tank line 0 tree roots
~in sewer line 0 fOOlign objects
o oth.r 0 sludge
o soap residue
o other
CHARGES
sink....................,................ $
tub.......................................$
_.............................,......$
lIoordrain............................$
Iaundry................................$
septic lin.............................$
mai~"';wer.:::..r............$
!~ $
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TOTAL FOOTAGE CLEANED:
KNIVES USED
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JOB DESCRIPTION AND REMARKS:
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. 'TOTAL
f'I.EMlEPAYAUATHSfNOCE
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OPERlITOR SIGNATURE
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CUSTOMER SIGNATURE
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A service charge of 1 112% per month (18% per annum) will be charged to aU accounts past
30 days. Costs plus reasonable attomey fees to be added in case of suit for collection.
, )at',~:;
"1127/2005
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,heets, Carol
73 Richards Rd.
lubuque, IA 52003
633 Chestnut
Pubuque, IA 52001
SERVPRO OF DUBUQUE
1044 IOWA ST.
DUBUQUE, IA 52001
Phone # 563-584-2242
.~~~~~;-f...~EP_~e~~~lEWCHIEl=~STI~!~~]~U!~i~~TE_~R~:1
nsurance: Water Damage
417.99
0.00
Qualifying Statements: The customer acknowleclges that permanently discolored, faded and/or bleached areas
on carpet. upholstery, drapery or other types of material sometimes make it impossible 10 restore the original
color or condition. Spot Removal is not guw'anteed. PLEtlSE SEE THE A01)!TION!~\L TERMS AND
SOND1T!ONS OF SER\l1CC ON THE REVERSE SlOE.
TOTAL
i $417.99
,____.,___~_~._____,______.J_______~
r have read the Terms and Conditions of Service on the reverse
side hereof a.nd agree to same,
TEP'M~'; OF P'::.YMEG-1T: UnlESS otl18rvvise speciHed on this invoi(;,'.~
payment is due in lull upon completion 01 service_ Interest wiil :)8
charged at il18 ma:dmum allowable bv law, or at -i .5% per iTlOlllll.
v!l1ichevef is lesser, on accounls over 30 days pns\ dUe.
(X)
/\uthorizec1 Signature
1 No One Home
r'''"---
I IF PAYMENT IS NOT RECIEVED IN
30 DAYS,
THE 1.5% FINANCE CHARGE WILL
LBE.MSES~EI2I'ER.MQNTH.
i hereby acknowledge the satisfactory completion of the above~descrjbed work.
fiC
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C~ustomer Slgnatui"e
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Locally Owned and Operated
PAUL HERRIG
PLUMBING, INC.
ROTO-
(ltO!E!~~.
_ 5nVlCE
" And A"'tlv 00 q~ow,les '2)0"''' the '2)Mi" " @
P.O. Box 1533. Dubuque, Iowa 52004. Phone 563-552-1828
. TV Camera Inspection & Video Recording
. High Pressure Water Sewer Cleaning' Electric Sewer Cleaning
CUSTOMER'S
ORDER NO.
C" ~lz"') \l\~-\- DATE )7~ ,)) 20
,
"., '\-
~31
NAME c' 'A\2~ /~ H'7'g , ~ ~'" (. . .-.,-;; (. ">
~ rv~DDRESS " 3> . ~ lJ J't-f"Jt S !?J-~R ~ :i/"
7?'~ Ff? 5"1' 2l (') ltY) Fp.< ~rl', 'i:S L.L ^ ?'-<,,>~"1-, \ .-,..:5 ,J. "'" r, is
I r-'<_ "'- ~,-',) ~~ \ """, L';:'~lt;"
HERE'S THE PROBLEM I FOUND AND FIXED. CHARGES '
YOUR: WAS CLOGGED BY: sink......... ...................... ....$
o sink 0 grease
o tub orshower 0 food lub....................$
o toilet ~ or sanitary products toilet.......... ..................$
o laundry / washer lines 0 hair
o floor drain 0 Iinl floor drain.. .................. .....$
o seplic tank line 0 tree rools laundry...... ..................... ..$
);imain sewer line 0 foreign objects
o other 0 sludge .' septic line.................. ........$
o soap residue f j ~lC""1
.-0 other malnsewer......;< ..$ Ie- _:)--
$
/O)t:jl'1\~
TOTAL FOOTAGE CLEANED:
9v I KNIVES USED ? ~ "
lj:',
,
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$
$
JOB DESCRIPTION AND REMARKS: "r f c; )'''' d -\ y... ">..
m~, IA )', ~ L F<..l \)~ () 6,Qc;.\k ",,!r\l?"- $
6V'/',,~t.)h\ i"''i: ." \i','\'f'\:'<""~ '""_> 'j \"'\'<;f~~'" O{;. r:.&::
( 6'~i''<:: < "0\', ", c' (.,;:, ...~. TOTAL &,5<6~~
~r~'~ ,(T '" "" If" 'lDr.::, )- PlEASEPAY~~tJt.J\lOCE
CUSTOMER SIGNATURE oPt~A'f~~9' '1.. \.\..'<?
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.