Claim Skahill, Michael & Barbara
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA:!;'^" 1(1.
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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.
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1. Name of Claimant: 1)?1f::fh9I7l...)' 13 /liZ iJ fl.e:.a Qmrlll>L
2. Address: ,;r711 f..?I'}~Clzd'-- '/)'~)-~{;"i)tP", ~A
3. Telephone Number ~-JZ.3-.S:P7 - 9>z'3
4. Date of Incident:
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5. Time of Incident:
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6. Location of Incident (Be specific):
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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.)
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8. What were weather conditions like?
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9. Give name and address of any witnesses:
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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. 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.)
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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?
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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
5
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day of ,J vi. </
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In (Crf.4&7_ ::r SY4#d....L- JJfrL..-I/fL4 S/Mlt<-
(Signature)
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(~nt Name)
{3;c-f<c~ CO S~
Date
n~VoiGeNo.1138687
Skahill, Mike
2794 Oak Crest Dr.
Dubuque, IA 52001
SERVPRO OF DUBUQUE
1044 TOW A ST.
DUBUQUE, IA 52001
Phone # 563.584-2242
Joa DATE
7/'V2oo6
REP
SOURCE
ZONE
CREW CHIEF
ESTIMATOR OUTSloe Il:iRR...
Sorvices
lnsw-ance:Water Damage
1,471.76
0.00
Ql,I.a.lilying Statements: The;, customer acknO\l'M(1gei lnal p~!'ma.llentty d~coIDrsd.1aded and/or bl"aChed areas
on Clilrpel, lJl3holslery, draP'lry Of other typeS 01 material eomatlrnQ$ make it imp05Sibllil to restore the original
color or oondiUon. Spot RsrnovaJ Is nol guaranti:Jed. PLEll~1::: ~I:.t;. I tt~ AUOlTIONAL T~RM:S AND
CON omaNS Of SERVICE ON THE AEVEASE SIDE.
TOTAL
$1,471.76
I have read tl1e Terms and Conditions of Service on the reverse
side hereol and agree to same.
TeRMS OF ~AYMe::NT: UnlliiSS otnerwisa op8c1tiild on tt1i5 involeQ,
payment is duB In full upon completion of 5';lrvice. Interest will bti
chllrgEid at the rr.aximum allowabie by law, or at 1,SOk per montll,
VihK;hovc,r i;i5 laaaer, on ;;\.OOQuntc O\l6r SO dillY" ~t due.
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Authorized Signature
I hereby acknowledge the satisfactory completion of the above..<Jescribed work.
I Due upon reccipt
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Customer Signature I No One Home
29502 05/02 Ot1tl."t _ OriMiDal hlVoice Ycllow - BUlintl cop~ GteCll- Reponing Copy Pink - Cllslomer Copy 'J,"" W tIIlt: - 'I raine! Ba.cx ;jMet - '~ciI1 F'1l1,;
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3nBnsna jO O~d^~3S
W0~~85E9S
51:01 900~/111L0
.
SERVPRO OF DUBUQUE
FIRE RESTORATION, Mom MlTIGATION, & WATER MITIGATION
ZOO6-07-03.11~1
ROOlD: DRYING
Air moVer (per 24 hour period) - No monitoring
Dehumidifier (per 2A hour period) - Large - No monitoring
12.00 EA
3.00 EA
Room: SERVICE CALL
Emc;rg,=n""y tliCJ. vico call - aftcl" 'bwoinc::is hours
Haul debris - per piokup truck load - including dwnp fees
l.00 EA
l.00 EA
Main Level
Room: HOT TUB
Tear out wet non-salv. glucdn. cpt, cutlbag- aft. bus. hrs
Apply anti-microbial agent - after hours
Tear Oul wet carpel pad, cutlbag - afier bu:;ine.. huw',
Tear out wet non-salvage cpl, outlball - after business hrs
Ceiling Height: 8'
299.UU SF
299.00 SF
299.00 SF
299.00 SF
Room: COMPUTER
Cei1int:: Ilelght. 8'
141.56 SF
141.56 SF
141.56 SF
Apply aJlti-microbial allenl- after hours
TeaT ODt wet carpel pad, cutlbag - after business hours
Tear out wel non-salvage cpt, cut/bag . after business hrs
Room: LAUNDRY
Ceiling Height; 8'
3&7.19 SF
387.19 SF
Apply anti-mi"Tobial ascnt - o.fter bol.1TE:l
Clean floor
Grand TGral
1,471.76
T etty Lenstra
2006-07-03-1141
07/06/2006 Page: 2
80 39\1d
3n~nana jO O~d^~3S
Z00ZZ89899
9!:0! 900Z/!!/L0
SERVPRO OF DUBUQUE
FIRE RESTORA nON, MOLD MrrlCTA TION. & WATER MITIGATION
Grand Total Areas:
1,61111.00 8FWalls
827.75 SF Floor
0.00 SF Long Wall
827.75 SF Ceiling
91.97 SY Flooring
0.00 SF Short Wall
2,515.75 SF Walls and Ceiling
211.00 LF Floor Perimeter
211.00 LF Ceil. Perimeter
827.75 Floor Area
1,752.00 Bleterior Wall ATe;<
899.42 Total Are.
219.00 Exterior Perimeter of
Walls
1,688.00 Interior Wall Area
0.00 Surface Area
0.00 Total Jotidge Length
0.00 Number ofSquares
0.00 Tolll1 Hip Length
0.00 Total Perimeter Length
2006-07-03-1141
07/06/2006 Page: 3
P0 38\1d
3nBnena jO O~d^~3S
1:001:1:89E99
91:01 9001:/11/L0
07T11/2006' 10: 15
5635822002
SERVPRO OF DUBUQUE
PAGE 05
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Locally Owned and Operated
DARRYL HORKHEIMER
D.B.A. ROTO-RooTER
811'I'II-
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. Ami A-If C;o 'ltOuJU9 'Do_ t4e 'Zm.llt . $
P.O. Box 1533. Dubuque, Iowa 52004. Phone 563.552.1828
. TV Camera Inspection & Video Recording
. High Pressure Waler Sewer Cleaning. Electric Sewer Cleaning
CUSTOMER'S
ORDER NO.
NAME j"(\ \ l;€,
-S~bJ\
ADDRESSL. 7Cf (.1 ex., 1:..(\ e~., t
/4."....
HERE'S lHE PIlOlI.EM I FOUND ANDmeo:v d.. l {"\
YOUR,
a sink
a lUll or_
adll
a laundIy I washer_
Jalloor drain
a septjclllnl,!ne
allllin _fine
a ollie<
WASClOGGEOBY:/ . \
,- 'i
a gIM88 !.
alood
a paper or SllI1IIa1y procIuds '.
Ohair {\/.4'1
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Qtree,l'QOts __ /r~- ,", ,""')./;
a forIign olljeda \:) l..) 71
Oslutlgt
a soap resldue(n, A
Q OCher _" _ _ ' ,_d"';\.
--7 /' t
DATE 1/ I
663 $57 q723
", t - LA, <~7/-,j t
tJ {yt. ;->~ ,~"" "
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20 \... )'(j
CHMGEs
sink..... .......... ............... ....... .$
lUll.......................................$
1llIIet....................................\ 31 4,Q
lIoordlain............................$, j'
laundIy.............................. $
sapliClInl;..........,........._..l
main _..........................$
I.'. ....,!'. ("
w_'id.i\ $ ~-_' - ..~~
CC,~ $2.00
~NfVEsJ~f <\ ;,' ", II C ( Cto
'.... J~' ".. I U $ ',:;J'\.) . .
7%'f/ ill,,~
$
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TOTAl t. f 7,\;;;,,;.
~PIIIr~ JlIIU::u.
~ili~ltr\
TOTAl. FOOTAGE CLEANED: .3 ~ .
JOB flfSCIIfI'1'IeH AND AEl r..
'~SIGNA1URE
,
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A_chOI9tGl, '...._<1_ ...-....""....................
30 daya. Coel$ plus __ allornoy fees 10 lleliClll8d In.... oIl1!li1lOrCllll8dlQll.
Behind J&J Pool. 3120 Cedar Cross Ct. . Ph. 582-5n5
ToGo
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CARPET OUTLET
..too. 10 am to 8 pm. Tues. - Fri. 10 am to 6 pm. Sat. a am to 12 pm. Sun. By Appl.
SUperstore
SOLD TO
Invoice
~jk\~ Sk~i;j
27'N Oak Cl"!'lt [.If
DlIbllqllf, iA nDDI
DATE
;f~t:lt}O,
INSTALL DATE
7;S!:J,)f;t
,
C<llJlttlll "'lj,l' ,
J4>oll<l 'mll"'I,z, '
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lIUClIll '
T_U..
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TOTAL
ITEM
TOTAL
$l.,MUG
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Buyerdl_.' If.....no.....or..........nwu...W...Mdiilllr'hei'tIlYfIiBlIlrIir....., ..~:~~i .:'".. ,".. ',~..... .. ...... .... .. ',' _
't'tt9rewl1lbll"2O%lWtDl*lngttlllJl8Ol'1ll11c.nC8"h.lMCClI'Ib'lillIISll)r.~orcutOn.n~Ifiit"~_~r:JlIWchandIie.~manuhlctuhlrwll1nof~IOfNlltJmC8f'lnOtbe
cneAed after IhllI8 (3) days 01 $lit of ltli& form. s,.'1iIgning' \he .~....Io the tenns.1l'Id <<n::lIticlni".tt8Iiild ~fOitn"
,>"
';",
Mike Skahill
2794 Oakcrest
Dubuque, Iowa 52001
Re: Damages from waterbackup in storm sewer and water main break 6/3012006
Barb & Jim cleanup mud and water 6-30-06 4hrs ea @$25.00 per hr..industry standard is
$38.00per hr $200.00
Roto Rooter 7-01-2006 clean backed up basement drain
$177.72
Mels Carpet Outlet
$1240.50
7-01-2006 rip out and dispose old wet carpet and replace carpet
Serv-Pro 7-1-2006 thru
drybasement and de humidify $1,471.76
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3ti 61, c; r