Claim Flynn, ElmerCLAIM 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: Elmer Flynn
2. Address: 1310 Oeth Ct.
`
3. Telephone Number: 563 588 9780
4. Date of Incident: April 6, 05
5. Time of Incident: 6:55 AM.
6. Location of Incident (Be specific): Entire finished basement flooded with 3"
of storm/sewer water from City backup.
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.)
At 6:45 A.M. Elmer went downstairs and found approx. 3" of water - then called the City & 2 guys
came & said the City line is pluged, backed up at Southern/Cross Street. One guy went to unplug
it. When asked ifit is the City's problem, the big guy said Yes.
8. What were weather conditions like? Dry, clear skies.
9. Give name and address of any witnesses: Carroll & Rob O'Neal, 1325 Oeth Ct. at Dubuque
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, just personal items were damaged.
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.)
Ruined approx.1200 sq. feet of carpet & padding, 8 pieces of furniture, some clothing\
items, 1500 carpet & padding; $450.00 misc. items; $5136 to heater or partial
$50 to have cat checked.
13. What other damages do you claim, if any?
I want reimbursement or partial for carpet removal and sanitation and for carpet
and padding replacement rest of the cost est. inclu. new carpet & padding.
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? To be reimbursed
for the Kanndo receipt for removing carpets & sanitizing (see attached).
16. Why do you claim the City of Dubuque is responsible? Routine maintenance of drains on city lines must not have been done often
enough to prevent this situation or back valve may have been faulty.
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?
N/A
Dated at Dubuque, Iowa this day of , 20 .
E.J. Flynn
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
. .
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CLAIM AGAINST THE CITY OF DUBUQUe"IOWA /. V- /a~
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:/{~--?JU -1 1{;(~ 0'1..
2. Address: I 3 /0 Cdh C/.
3. Telephone Number:
503- 5cYf- 17PO
4. Date of Incident: ~ tr 0 .5
5. Time of Incident: ft:; 5 5.4-1rl
6. Location of Incident (Be specific):~ ~U!..-c/ j;~~
t-
J I~7JdLc:l ~A 3;1 1r1_ .~#Y7 / ~;{J~ IAJtLD /). / ^ fm U/ ,bCUL
~~ ~ { t~ / ~}?_
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.) 3 {I
eLL 4- ,/S~ An7 ~ ~ /~~ ~J ~~~o-V
~wdL/L _ ~ O~/L-r'/ tIu {.A Lu./ ;(~ G~ cI- Scu.,--! hh_
cay ~ 0 ~~ ba-~,/ud up;{.l: /~~ I {!/'lAJ~ ~,,'~
(;fu--"-I i;.v-uvf k a-n ;U.<":9 J; t-J /U/VI t:J..V.L<~ ~ J -/:;.)u ~ ,/.1A~~
vt:h/ ~ ~.Ya~ ~- / _
8. What were weather conditions like? ~ / ('.-Le M 5 k::t.L.::J
9. Give name and address of any witnesses: Ca/z~ ~ ,.e{) b d /ltJ ~
/3~:5 f>>:f;:f7 e1- ~&u F T
10. Did police investigate? (If so, give names of officers.)
AlO
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
AI 0" :r~M ,/JL,1~71a----! vtJA/t~ ~ rL~r2fY'~
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.)
NO
. 15,. What amou'lt;do you clai~ ~m the City of Dubuque? .:20 ,6.{ N.kn-Uj.(,~/U2~('/ .
frY/) HU K a/V1/ht{;() ./U u-e,j2A M.:{ N /J1 m 1/'<; CLJ.Ape.6;J 4 5aru.-cvj<: VYlC
L> SLe. O-::t:ta ct U'./ J
16. Why do you claim the City of Dubuque is responsible? J!ffhil~ /1VJ~<<..i
q d~i1vJ tTJ1 c~ .L~/J '7rUuv{ ~d /iav-t Lu.~/}/1 d~ tJ1lt~'#--
-t-D fYlR-~ t-Iu/J ~, ?J7 /5cvc /2 t/c;~-e r( /77 ~ /tatY
l~ve~Claim against anyone else for damages as a result of this incident?
(If yeo give name and address,)
N/
18, If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Nit-
Dated at Dubuque, Iowa this
day of
, 20_,
.. :'J
~~ c, ~
(Signature)
~ '- J, Fir Ai }/
(Print Name)
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(Rev, ~!OO & 7/01)
PICK UP DATE:
NAME:
STREET:
CITY/STATE.
PHONE:
ITEMS TO BE PICKED UP
DONATION VALUE: $
(To Be Filled in by Donor)
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Thank you for your donation. It helps us me2t th needs
of many people in the name of Chr.'. II '
J ~ ,,<
T ft Store Manager
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o If box is checked, an Item was determined unusable due to its
condition. We are sorry that we are unable to use this item.
SPECIAL INSTRUCTIONS
THANK YOU
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ETLANDUSA
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Pboae(563)5Il-12OO h(1Q)sa..os10
4015 ~ Dr.
Dubuque. IA stOOl
(583) 582-12OCl
I&83l 582..0310 '1IlIl
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Attn: Elmer Flynn
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950 Main Street
Dubuque, IA 52001
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563-556-6168
800-556-6168
Fa'{: 563-556-4680
April 29, 2005
Elmer Flynn
1310 Oeth Court
Dubuque, IA 52003
588-9780
Invoice: Sewage Damage Basement Floor
. R & R contents
. Clean and disinfect bottoms of contents
. Box up contents
. Remove damaged carpet and tile
. Steam clean cement floors and steam clean steps
. Clean shower and bathroom fixtures and disinfect
· Disinfect cement floor $1,295.00
. Trailer to landfill and fee
$ 125. o~/-._._----------"
/
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Thank you for calling KANNDO Profession I Services! I
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Total:
Molo Plumbing & Heating
123 Southern Avenue
P.O. Box 1540
Dubuque, IA 52003-1540
Phone: (563) 557-8755
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Invoice
Invoice Number: DS36054
Invoice Date: 4/28/2005
Page: 1 of
Bill To: 21975
ELMER FLYNN
1310 OETH COURT
DUBUQUE, IA 52003
Service 006126
Location: ELMER FLYNN
1310 OETH COURT
DUBUQUE, IA 52003
Work Order 10
050427-002
Complete Date
04 /27/2005
PO Number
Terms
Net 30 Days
Called In By
Description of Work
CUSTOMER REPORTS 5" OF WATER IN BASEMENT AND WOULD LIKE THE UNIT CHECKED OUT
FOR ANY DAMAGE - INSPECTED AND FOUND NO WATER IN THE FURNACE, THE WATER DID NOT
REACH THE BLOWER OR CONTROLS.
CYCLED UNIT - SYSTEM OPERATION IS NORMAL.
THANK YOU FOR YOUR PATRONAGE
Qty
ItemlD
Description
Date
Unit
Price
Disc % Amount
Labor
1 :00 REG
Scott Estal
4/27/2005
48.00
SubTotal
48.00
48.00
ASK US ABOUT OUR MOLO MAINTENANCE PLANS AND SAVE
$$$
Invoice Subtotal
Sales Tax
Invoice Total
Payment Received
Balance Due
48.00
3.36
51.36
0.00
$51.36