Claim, Neyens, Steve & LeslieCLAIM 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: Steven K. & Leslie E. Neyens
2. Address: 850 Kane St. Dubuque IA 52001-1747
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3. Telephone Number: 563 556 5212
4. Date of Incident: Aug 11th, 2005; Early morning 2" Rain; Aug. 18, 2005; Early & Mid Morning 2.4" rain
5. Time of Incident: See above
6. Location of Incident (Be specific): Driveway at 850 Kane 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.)
Rain Storm Water Runoff from Kane Street backed up at Catch Basins and overflowed
the curb and washed out the private Driveway.
8. What were weather conditions like? Heavy Rain
9. Give name and address of any witnesses: None Known of
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.)
Gravel Driveway was washed down the hill. I hired Perry Const. to repair damage.
The bill is attached.
13. What other damages do you claim, if any? No
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?
$360.00
16. Why do you claim the City of Dubuque is responsible? Rain fell on City Street then the Water Overflowed the Storm
Drains; Built up in the street until it overran the drive approach then down the Driveway.
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 16 day of September, 2005.
/s/ Steven K. Neyens
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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CLAIM AGAINST THE CITY OF DUBUQUE,~"IOWA . . '~Vt/Lr,
This written report constitutes your claim against the City of Dubuque, Iowa. You ShO~ tl n 't/
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.
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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
emplgyee's name.)
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9. Give name and address of any witnesses:
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8. What were weather conditions like?
10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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12. Was any damage done to property? (If so, describe property and the extent of damages.
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13. What other damages do you claim, if any? IJ 0
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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.)
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15. What amount do you claim from the City of Dubuque?T~ -1 c.-, (';--
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16. Why do you claim the City of Dubuque is responsible? lilt.! (DA 1 ~_ () If P;'R F!o(gJG:D
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) I!../o
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
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(Rev. 1/00 & 7/01)
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Perry Construction
10600 Freedom Ridge Dr.
Dubuque, IA 52003
Invoice
nvolce #
9/9/2005 6328
Bill To
City of Dubuque
50 W 13th S t
Dubuque, la 52001
Attn:Steve Neyens
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P.O. No. Terms Project
30days
Quantity Description Rate Amount
850 Kane St. work done at alley
6 1" clean base stone @ $9.00 per ton used 9.00 54.00
8 3/4" road base stone at $7.00 per ton 7.00 56.00
5 Labor rate of $50.00 per hour 50.00 250.00
Thank you for your business. Any questions, call-556-8065 Total $360.00