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Claim Stonskas, Dianna lf1!./1 11,.1 . '-<7 _~\\.J\" f?',~ This written report constitutes your claim against the City of Dubuque, Iowa. ou should complete this form in full and attach any additional information that supports your claim. ,. Ct!- '. CLAIM AGAINST THE CITY OF DUBUaUErlOWA ' 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: D l 0..-"\ 1'\ 0... ::5 -t'D V1 5 k"^'- 5 2. Address: d.. '-I '? -:;- W ..(2 s--f "5-{-- .. 3. Telephone Number: S-&:>.3 - 5" S- to '( 0 I Z- 4. Date of Incident: X 0......1'\. :2 3 I :J..0lJ S- . 5. Time of Incident: 1) e--h..t )..e..---e K q '{ 3 0 c-t -1\ c:l I 0 : OZJ 6. Location oflncident(Be specific):.:J:f1 +--MI'\+ ct 0':l31o 7 uJes-f "5+' 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.) fJ !Uo..-fe,e. /Jlcu/1 !)K?~fe under -flte sfft!-ee-f; /,{)CJ-- +-et<:. ('t;Ll11e oJ 1k/J//1 v/Ilde/L7pW1d -/ble- a.-f/'6u,;---f c24...<::'S, 1/ie- -fbrc e- Oft d alllcJ?Ul-l- 17+ ?Val&:...- dPU11o.:J ed;J,eo /e.c..--;;;Cf: ; 8. What were weather conditions like? ~ l-e.CJ--K- D-V\...d C~ led 9. Give name and address of any witnesses: fhtd; G-CLU, -a'! r;'l ~Q s-t s-L III _ J c..0'>A.U"J.+Ck.o..clt'eG-<'<-<A . YlC K-€-'E::.d 220 . 3 JLd ,I<w: C.,. €.I u. 11 /..LAw A j..016 Be, IdZ- -d.'1op;o lTJin-eUf{ 5--r, 8"^-(' Cl..('CA.:e:;o/-e,&-c.-,'l;}... Flo,,-"-eM e ~, 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 dam,ages. Attach estimates of damages or describe basis for ascertaining extent of damage.) /JtAI1IClfF dcY/U2.- /Ae./udes /j{ulltecf(:~IXZT IA );,,>'f"jrye,rr!;e:l,eclPA7aAd ha/lwd(jj/JAf-elZ-IVct51/1 /n:5(?ba/'dtJ-nd Jd1;,.?J nP tatl/.!IIg(/tfc1R..ci /sctJtle,e(?c!/;?H!6d- 1A <z- de.cI! Ra;( )!otLd.-;-; es a. t'e. C{ -'Y'Y/aef' 11e. +:/! 1m.5 iUlsled aa::1l!1a!t IfJ /1- LlJJ ~ld/e; 13. What other damages do you claim, if any?-rJe dt.tp/1tlq,2. fo -f~12 fJi"fi:5G II>>/! (I- k (f K/!otdJtorh'/ 6jJt:-(1J~ !u!J<<)j lIRe 10 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? /;;<, {) 71 s I 1 liLts {lJl'!{)tu(T .(JJL. t;?s'S/)!e aR-e! 'tU'l~ 5 -roP1K#o?'-'#, (;JcJ5s;/d€ Jeffl'''j iOf<e,ce too! <"",;he I/jP 7U'PrVI1 t? "<~ -1' " 16. Why do you claim the City of Dubuque is responsible? 71112-- (,Lht -teL. 1l7a. 14 f!,4..T b/'oKe- r'5 r2-d(j 1,Qj1e~f:t, lie ('/'1;; /0 il.e~"PM5/ble {bKIl7U.IIff4.ti1iJ.- e l& 1z /ld Co !"/,Pf 'I.ie/lls" Y, da..f?lt2" ) " uJe-e. ~p. h/Z6'J!&1 '/;l1a./11 ' 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) (10 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 d... day of 1!ICV(('.4 , 20~ , [)M~ fro~ (Signature) ::D l?t i\Ylo... ;5-+0 ws ka"S (Print Name) 'it"" , ".1 .! ,I (Rev. 1/00 & 7/01)' "_. '--' . " 2485 West Sl Dubuque, IA 52001 March 1, 2005 City of Dubuque Dear Sir or Madam: I have enclosed a combination of bills and estimates for water damage to my property at 2485 West St which occurred on January 23, 2005. Also enclosed are photos with descriptions and dates on the back. This damage was caused when a water main broke under the street in front of 2367 West St. The water flooded my front and back yards. It also spewed up from under the ground in my front yard, causing fissures in my lawn, and covering my entire lawn with at least 2 inches of mud. I had as much mud removed and raked from the yard as was possible at this point. I won't know the extent of the damage until spring, when the ground thaws and settles. Therefore I may have to submit further estimates for future damage where the fissure occurred, because of the tremendous amount of dirt that was washed out from under the ground, possibly causing a sink hole. I have enclosed an estimate for the amount to re-seed my yard when the weather permits, The back yard will also need to be seeded. The water seeped into my basement where my two bedrooms are located. Enough mud and water came in so that both carpets in the bedrooms were ruined. Water also came in under the back door to the basement ruining the hallway carpet. I've since had them replaced and am submitting the bill with this letter. The damage to my deck was caused by the vast amount of water and the pressure of the water running under my deck, It applied so much pressure that the deck is now unstable, A lot of the dirt fill was washed out from behind the railroad ties which support the deck. I have enclosed photos and an estimate for the amount needed to repair the deck. I expect and appreciate the City of Dubuque to settle this matter as expeditiously as possible, Sincerely, f)~ ;J!fh~ ,.L Dianna M. Stonskas 563-556-9012 .' State Farm Insurance Companies@ STATI .AIM A INSUIANel . January 25, 2005 Fire Claims Central P.O. Box 82539 Linooln. NE 68501-2539 888 429 5077 Fax 888 429 50 DIANNA STONSKAS 2485 WEST ST DUBUQUE IA 52001 RE: Date of Loss: Claim Number: January 23, 2005 15-E079-242 Dear Ms. Stonskas: This letter is in follow-up to our conversation on January 25, 2005. Per our discussion, you advised me that the water entered through your foundation walls in your basement. As we discussed, this is specifically excluded under the Homeowners Policy. The portion of your policy that addresses this is Section I - Losses Not Insured, 2.c.(3): SECTION I . LOSSES NOT INSURED 2. We do not insure under any coverage for any loss which would not have occurred in the absence of one or more of the following excluded events... C. Water Damage, meaning: (3) Water below the surface of the ground, including water which exerts pressure on, or seeps or leaks through a building, sidewalk, driveway, foundation, swimming pool or other structure. Although we are unable to provide coverage for your claim, we hope we have handled your claim in a prompt, courteous, and professional manner. We understand you do have a choice when it comes to your Homeowners insurance and appreciate the fact that you have chosen State Farm<l!> to be your insurance carrier. HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 " If you have any additional questions or concerns about your claim, you may contact us at the number below. Our office hours are 7:00 a.m. to 9:00 p.m. Monday through Friday, 8:30 a.m. to 5:00 p.m. on Saturday, and 12:00 p,m. to 4:00 p.m. on Sunday. Sincerely, [[}~~ ~if Claim Representative 1 888 429 5077 State Farm Fire and Casualty Company 485/0125008NE cc: 15-3420 Agent Joe Buchheit CARPET ONE@/&J CARPET SHACK Md~~, 1~ 587 University Ave. Dubuque. IA 52001 Pbone(563) 557-7212. FAX (563) 584-2086 ww\\',carpe toneCOITI ESTIMATE FOR Stonskas, Diane 2485 West SI. Dubuque, 556-9012 Estimate IA 52001 ESTIMATE NO. DATE 4120946 01/27/05 AREA DESCRIPTION QUANTITY PRICE TOTAL Bed rm & hall RUSTIC JEWElS-12'-S.. color to be selecle.. 33' 6" 402.00 Sft 1.11 446.22 " 3/8 ULTRA MAGIC 8 lB 66' 0" 396.00 Sft 0.35 138.60 " INS CPT: BERB-CONCR.. - 44.66 YARDS LABOR 4.95 221.07 " MTC: PD PIN -GOLD M.. KINKEAD METAL.. 4.60 LINEAR FEET 1.14 5.24 " INS CPT: METAl-CONC.. - 4.60 EACH 1.50 6.90 Diane's brm ULTRA COLOR II color to be selected 21' 3" 255.00 Sft 2.36 601.80 , 112" SUPER MAGIC 6 lB 42' 0" 252.00 Sft 0.35 88.20 " INS CPT: N-BERB CON.. install carpet 28.33 YARDS LABOR 4.75 134.57 , INS: MOVE FURN move all furniture 1.00 EACH 125.00 125.00 This estimate is good/or 30 days. /fit meets with your approval, please sign and return SUB TOTAL 1767.60 TAX 89.61 I TOTAL 1857.21 [ SIGNATURE 950 Main Street Dubuque, IA 52001 ~'If ,~:>---'",",'/ f,,-_~ I'/~ 563-556-6168 800-556-6168 Fa;;:; 563-556-4680 January 23, 2005 Diane Stonkas 2485 West Street Dubuque, IA 52001 556-9012 Invoice: Emergency Water Damage Basement, Hall, 2 Bedrooms, Bathroom . Extract water and mud from carpet and pad . Remove carpet and pad and bag up . R & R contents and block up . Disinfect cement floor $ 550.00 $ 75.00 " $ 600.00 $ 300.00 ' Install Drying Equipment: . 4 air movers $30/per day/5 days . 1 pump-out dehumidifier $60/per day/5 days . Steam clean cement floors . R & R contents $ 210.00 · Landfill fee for carpet and pad ' $ 55.00 Sub-total: Tax: Total: $1,790.00 $ 125.30 $1,915.30 Thank you for calling KANNDO Professional Services! KLUCK CONSTRUCTION INC 14285 HWY 20 WEST PO BOX 1045 DUBUQUE,IA 52004-1045 To: Dianna Stonskas 2485 West St. Dubuque" IA 52001 Invoice ID: 93942 Invoice Date: 02-15-2005 DrawlD: Customer ID: STONOl Job Location: 2585 West St. Ship Via: FedEx Item Description 2/15/0 Remove and rake dirt from front yard, back yard and along wood fence, Washed in by broken water main, Flatbed Truck 2 Men labors Unit of Units Measure 3,00 hrs 4,25 hrs DATE DUE: 03-15-2005 Unit Price Amount Billed Retainage Held Amount Due Amount 165,00 340.00 $505.00 $505.00 Steve's Lawn Service Steven Wingert - Owner & Operator 603 l't St. NE Farley,IA 52046 February 22, 2005 Ms. Stonskas 2485 West SI. Dubuque,IA 52001 Ms. Stonskas: The following is my bid to fix and repair the damage to your yard (front & back). Labor: Materials: Disposal: 9 hours @ $40lhour grass seed & fertilizer waste off of yard $360.00 $100.00 $ 40.00 Total for job: $500.00 1 hope this covers your needs. Thank you for considering this submission and if there is anything 1 could do differently to help you in ANY way, please feel free to let me know and I'll be happy to work that out with you. Please let me know when you make your decision and thank you for giving me the opportunity to work with you. ~~w~ Steve's Lawn Service Steven Wingert - Owner & Operator Home - (563) 744-3732 Cell Phone - (563) 599-3420 KI,.UCK CONSTRUCTION P.O. Box 1045 Dubuque, Iowa 52004-1045 Phone: (563) 556-2284 Fax: (563) 556-2285 P'UlfztJ4at Page No. of Pages PROPOSAL SUBMITTED TO PHONE DATE Dianna Stonskas 556 9n12 1-31-05 STREET JOB NAME 2485 West St. 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 reconstruct the wood railroad ties that have shifted from the broken water main. We will shore up the wood deck dismantle and relay the railroad ties and replace the granular fill behind the wall. $7,300.00 WE PROPOSE hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: doliars ($ ). PAYMENT TO BE MADE AS FOLLOWS: AU material is guaranteed to be as spKifled. All work to be completed In a workmanlike manner according to standard practices. Any alterations or deviation from above specifl. cations involving extra costs will be executed only upon written orders, and will become an extl1l charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. AUTHORIZE SIGNATURE N E: THIS PROPOSAL MAY B WITHDRAWN BY US IF NOT ACCEPTED WITHIN DAYS. ACCEPTANCE OF PROPOSAL - The above prices, specifica- tions and conditions are 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 paid for 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.