Claim Stecher, Randall & Carol - Allied Ins.
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CLAIM AGAINST THE CITY OF DUBUQUE, IOW~1) ~
This written report constitutes your claim against the City of Dubuque, Iowa. You sh~uld
complete this form in full and attach any additional Information that supports your claim:
f,
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 t071 the
City Council. You will be provided with a copy of that report and recommendation. .s
l
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. f\\\'-e.~
1. NameofClaimant:~<A\'\Ajl,Ll_ ~ c.,~\ S.\-."'}"\""f.Y'"" ksu.r~
2. Address: \ '1 J-O ~DL\l A ...1.. R\) -\:Jv.I::u'1 \A.LTA '3 .Jot> "?
3. Telephone Number: :-)( v?' - '5-<; ~- 14- <3 Cj
4. Date of Incident: 01/ dO) DS-
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5. Time of Incident: l.\':, 0 \,'<Y'
6. Location of Incident (Be specific): WcJ.e.r ~Gl'r.. \{\~I\..\- t M &f'eSS
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.)
~I(.'\)L .lm 'I'\'\().,\~\..)oJt.rt,i\<- \-e.<>J/...l.-J. \o(A,c..\L..-J U-(l,,,,,h ~D....lJ~_
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8. What were weather conditions like? A1../fl
9. Give name and address of any witnesses: /V/f\
10. Did pollee 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 50, describe property .@nd the extent of damages.
Attach estimates of damages or describe basis for ascertaining extent of damage.)
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13. What other damages do you claim, if any?
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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.)
15. What amount do you claim from the City of Dubuque? ~ 1D31.3 S-
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16. Why do you claim the City of Dubuque is responsible? (\,l..,\ -:'\u,'P'9h.....J O>\.J
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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'}vD
18. If the answer to Question 1715 yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this
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day of
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(Rev. 1/00 & 7/01)
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STECHER, RANDALL J.
Property: 1720 ROCKDALE RD
DUBUQUE, IA 52003
Insured:
Home:
Cell:
(563) 557-1489
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Home: 1720 ROCKDALE RD
DUBUQUE, IA 52003-8051
Claim Rep.: Tom Downing
Bnsiness: (800) 532-1212 x8323
Business: P.O. Box 155
Dubuque, IA 52004-0155
Estimator: Tom Downing
Business: (800) 532-1212 x8323
Business: P.O. Box 155
Dubuque, IA 52004-0155
Claim Number
14R44932
Policy Number
HMC 00009011152
Type of Loss
WATER
Deductible
$500.00
Dates:
Date of Loss:
Date Inspected:
Date Est. Completed:
07/20/2005
07/22/2005
08/28/2005
Date Received:
Date Entered:
07/20/2005
07/22/2005
Price List:
Estimate:
IADU4B5C
RestorationlServicelRemodel
STECHER__RANDALL~_
Dear Valued Customer,
Please refer to the enclosed itemized estimate of repairs to restore your property. This estimate represents the covered
damages for the reported loss and was prepared using local cost. UYDU choose to hire a contractor, please provide this
estimate to them.
If any hidden or additional damage is discovered, please contact me or have your contractor contact me immediately.
Before any supplemental payment would be considered, coverage for the hidden or additional damages would need to be
determined and may require an inspection. Please do not destroy or discard any of the hidden or additional damages
until we have reached an agreement on the supplemental cost.
If a mortgage company is included on your claim payment check, please contact the mortgage company to discuss how to
handle the proceeds ofthis payment.
Thank you for allowing Allied Insurance to serve your insurance needs. Should any questions arise concerning this
estimate or anything else concerning your claim, please contact me at the numbers listed above.
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STECHER__RANDALL_J_
Main Level
Area Items: Main Level
DESCRIPTION
QNTY
1.00 EA @
UNIT COST
TOTAL
0.00
Emergency service and dry out
Waiting for Kanndo Restoration invoice.
Room: Family Room
DESCRIPTION
QNTY UNIT COST TOTAL
369.31 LF@ 0.79~ 291.75
369.31 LF@ 3.20~ 1,181.80
1,258.28 SF @ 0.13 ~ 163.58
1,447.02 SF @ 3.60 ~ 5,209.27
1,258.28 SF@ 0.65~ 817.88
1,258.28 SF@ 0.26~ 327.15
1,258.28 SF @ 0.34~ 427.82
4.00 HR @ 29.11 ~ 116.44
Stain & finish baseboard
R&R Baseboard - 3 1/4" hardwood
Additional labor cost for Berber or patterned carpets
Carpet - High grade
15 % waste added for Carpet - High grade.
The carpet has a 24 n pattern match and is a berber.
Pad - rebond, 3/8", 7 lb.
Tear out wet non-salvageable carpet, cut & bag for disp.
Tear out wet carpet pad, cutlbag - Black water
Content Manipulation charge - per hour
Grand Total Areas:
3,452.27 SF Walls 1,295.86 SF Ceiling 4,748.13 SF Walls and Ceiling
1,295.86 SF Floor 143.98 SY Flooring 402.06 LF Floor Perimeter
0.00 SF Long Wall 0.00 SF Short Wall 420.72 LF Ceil. Perimeter
1,295.86 Floor Area 0.00 Total Area 3,452.27 Interior Wall Area
1,499.99 Exterior Wall Area 187.50 Exterior Perimeter of
Walls
0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length
0.00 Total Ridge Length 0.00 Total Hip Length
STECHER RANDALL J
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Summary for WATER
Line Item Total
Material Sales Tax
@
7.000% x
5,988.32
8,535.69
419.18
Subtotal
8,954.87
Replacement Cost Value
Less Depreciation
8,954.87
(1,923.52)
Actual Cash Value
Less Deductible
7,031.35
(500.00)
Net Claim
6,531.35
Total Recoverable Depreciation
Net Claim if Depreciation is Recovered
1,923.52
8,454.87
Tom Downing
STECHER RANDALL J
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Recap by Room
Estimate: STECHER_RANDALL_J_
Area: Main Level
Family Room
8,535.69
Area Subtotal: Main Level
8,535.69
Subtotal of Areas
8,535.69
Total
8,535.69
STECHER RANDALL J
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100.00%
100.00%
100.00%
100.00%
08/28/2005 Page: 4
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Recap by Category with Depreciation
O&P Items RCV Depree. ACV
CONTENT MANIPULATION 116.44 11 6.44
GENERAL DEMOLITION 858.38 858.38
FLOOR COVERING - CARPET 6,190.73 1,547.69 4,643.04
FINISH CARPENTRY / TRIMWORK 1,078.39 215.68 862.71
PAINTING 291.75 58.35 233.40
Subtotal 8,535.69 1,821.72 6,713.97
Material Sales Tax @ 7.000% 419.18 101.80 317.38
O&P Items Subtotal 8,954.87 1,923.52 7,031.35
Less Deductible (500.00) (500.00)
Grand Total 8,454.87 1,923.52 6,531.35
STECHER__RANDALL_J_
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contents
07/22/2005
STECHER_RANDALL_J_
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2 no contents damaged 07/22/2005
STECHER_RANDALL~_
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quality of carpet re
07/22/2005
STECHER RANDALL J
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risk
07/22/2005
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to the storage room
07/22/2005
STECHER__RANDALL~_
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warped base tim
07/22/2005
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Waterline repaired b
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07/22/2005
city of dubuqe repaired water line
08/28/2005 Page: 12
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