Claim Kaesbauer, RobertCLAIM 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: Robert Kaesbauer
2. Address: 2791 Oakcrest
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3. Telephone Number: 583 1034 ??
4. Date of Incident: 6 30 06
5. Time of Incident: 4:45 P.M.
6. Location of Incident (Be specific):
Corner of Oakcrest & Berkeley - broken water main.
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.)
Flooded basement due to broken watermain on Berkley.
8. What were weather conditions like? Clear
9. Give name and address of any witnesses:
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.)
Flooded basement with muddy water. Had water pumped out and basement cleaned
by ServPro.
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?
$1,331.42
16. Why do you claim the City of Dubuque is responsible?
Broken water main caused by Street Collapse.
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 7 7 06 day of , 20 .
/s/ Robert P. Kaesbauer
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
. .
C/c,'/J1.r>"~cd~r: /'{/'/{4.
CLAIM AGAINST THE CITY OF DUBUQUE, Io'WA~~k/
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 West 13th St..
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. 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: 1" $t!'1c,-r- fA ~-?s (3 Rc/ g 17. ,
2. Address: .2 '1 7,/ ('5 A-,!:: <:' 1;; [;:{;> ~
3. Telephone Number :):5.,3- /tl9',J',<.J
5. Time of Incident:
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4. Date of Incident:
6. Location of Incident (Be specific): r(
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7. Describe the 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.)
r:'/.. 00 PC 17 1M s t" /n P-A/ .r pv E 70 ,B',;r?c, ~ C /!./
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8. What were weather conditions like?
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9. Give name and address of any witnesses:
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).
(i/o
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.)
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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.)
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15. What amount do you claim from the City of Dubuque?
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16. Why do you claim the City of Dubuque is responsible? = V
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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.)
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18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Dated this 1- '/- de day of
U?~-c?-(~~
(Signature)
~c! tff!:./?--r 'f? ~ 6S /.3 /Y'u z:::;'C
( rint Name)
, 2004> .
-I
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..1
SERVPRO OF DUBUQUE
FIRE RESTORATION, MOLD MITIGATION, & WATER MITIGATION
c.t....~I"'"<r Co~
Client: KAESBAUER BOB
Home: (563) 583-1034
Property: 2791 OAK CREST DRIVE
DUBUQUE, IA 52001
Operator Info:
Operator: OWNER
Estimator: Terry Lenstra
Business: (563) 582-7776
Business: 1044 Iowa street
Dubuque, IA 52001
Type of Estimate: Water Damage
Dates:
Date Entered: 07/01/2006
Date Assigned: 06/30/2006
Price List: JADU4B6B
Restoration/Service/Remodel
Estimate: 2006-07-01-1649
SERVPRO OF DUBUQUE
FIRE RESTORATION, MOLD MITIGATION, & WATER MITIGATION
2006-07-01-1649
Room: DRYING
Dehumidifier (per 24 hour period) - Large - No monitoring
The above entry is for 2 dehus for 4 days
Air mover axial fan (per 24 hour period) - No monitoring
The above entry is for 2 tri axial fans for 4 days
We were unable to set any additional equipment, due to the limitations of electricity in the basement
8.00 EA
8.00 EA
Room: SERVICE CALL
Emergency service call - after business hours
Water Extraction & Remediation Technician - after hours
The above entry is for 3 people for I hour to squeegee the floors in basement
1.00 EA
3.00 HR
Main Level
Room: POOL TABLE
Ceiling Height: 8'
Apply anti-microbial agent - after hours
Clean floor
561.58 SF
561.58 SF
Room: SHOWER
Ceiling Height: 8'
Apply anti-microbial agent - after hours
8.75 SF
Room: STORAGE
Ceiling Height: 8'
Apply anti-microbial agent - after hours
Clean floor
167.50 SF
167.50 SF
Room: LAUNDRY
Ceiling Height: 8'
Apply anti-microbial agent - after hours
Clean floor
196.25 SF
196.25 SF
2006-07-01-1649
/D%
1,479.35
1'17/'13
07/06/2006 Page: 2
Grand Total
1331'1.'-
'j),;}',,1. u;.~v. "'- 7 de>y.$
SERVPRO OF DUBUQUE
FIRE RESTORATION, MOLD MITIGATION, & WATER MITIGATION
Terry Lenslra
Grand Total Areas:
1,781.33 SF Walls 934.08 SF Ceiling 2,715.42 SF Walls and Ceiling
934.08 SF Floor 103.79 SY Flooring 222.67 LF Floor Perimeter
0.00 SF Long Wall 0.00 SF Short Wall 222.67 LF Ceil. Perimeter
934.08 Floor Area 1,006.69 Total Area 1,781.33 Interior Wall Area
1,698.67 Exterior Wall Area 212.33 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
2006-07-01-1649
07/06/2006 Page: 3
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