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Claim, Henkel C., Tittle, S.CLAIM 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: Cynthia Henkel, Stacey Tittle 2. Address: 2766 Oak Crest Drive, Dubuque, IA 52001 ` 3. Telephone Number: 563 582 7194 4. Date of Incident: June 30, 2006 5. Time of Incident: 4:30 - 4:45 P.M. 6. Location of Incident (Be specific): all rooms of basement at 2766 Oak Crest Dr. (864 sq. ft). 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.) Between 4 & 6 inches of muddy water flooded entire basement, entering via floor drain in laundry room, due to water main break draining into broken storm sewer system. 8. What were weather conditions like? Sunny & Dry 9. Give name and address of any witnesses: Jane Walker, 2756 Oak Crest Michelle Jaeger 2788 Oak Crest John Klostermann City St./Sewer Main. Super Vince Conner, 884 Berkley - City employee 10. Did police investigate? (If so, give names of officers.) Police blocked off intersection of Oak Crest & Berkley when street collapsed. 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.) Yes - see separate page 13. What other damages do you claim, if any? Service Master Cleaning expense and homeowners' labor and electric and water bill amounts inflated for July. 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? $5887.00 round up to $6000.00 for inflated elec. & water bills and labor to paint utility room floor. 16. Why do you claim the City of Dubuque is responsible? Michelle Jaeger called Dbq water dept. at 3 p.m. to report water running in the street. The lady transferred her and she left a message stating the problem, her name & phone #. No one returned her call and the street dept. showed up after the street caved in and the police arrived at approx. 5 p.m. If they had responded sooner and accessed the water boxes to turn the main off without delay, this whole mess could have been avoided. 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 23rd day of July, 2006. /s/ Cynthia L. Henkel /s/ Stacey Tittle (Signature) (Print Name) (Rev. 1/00 & 7/01) 7(z lJ!t'b Ci- ~'? 1'-1!t/;; CLAIM AGAINST THE CITY OF DUBUQUE, IOWA !; ~~( This written report constitutes your claim against the City of Dubuque, Iowa. You: ;J; should complete this form in full and attach any additional information that Z;.)) ';'7 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. NameofClaimant:4fi-thiat1fVlkfL) S-t(,(Cf.~. T;d:/e. 2. Address: ;)'7fvl.o Oat::: C,e..ES+ D",,',Vc. J)djCl~\'(f;IA 5.:).001 3. Telephone Number 610 2, -c; R d - 7 I 9 '/. 4. Date of Incident: Jt) VI E. 30 ~ OOh , 5. Time of Incident: 'f'. 30 - 4- : 'f -':,- 'Pm 6. Location of Incident (Be specific): all RooVVtS o~ bo.SfYVl'iVr1::- at Cl7",,-,OClk(RfSfDR.. Ui(cLis'b,ft) 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 ttie employee's name.) Bd,I.JHIfl 4--~ b. 1'11(1.1<<, ofVVlud.d~. (J,)Cltff<.f/ooduJ. <,,,f'f<, bClStltt'arc, "V1'kA1VlS \/ro. ..-t1o?1Z dR.Q/h IVI launclR'd- Room) dUf. -1-0 Id<lhp- "Mill blZ~qj(, ollZOIi1/vtCl ,vll:n bt<.or~h <,+r,R~V1 5(Jul\?R. :o~ ,hWI, 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). VlO 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.) YfS - 5U,: 5ffil.lCa+<- P"t' 13. What other damages do you claim, if any? S<oi<.v'\c.f W\a<'-to:c CIE(J,;1f'V\~ fXpf\1SF alA.d. 'nOl1dOWV1,R.<;' la.bo/1.. Qvvl f\1' ('"tH'Ie. "- i,'rAhl1.. b;\1 o'W\o'./I'l+-<' tY1%~cd:;~J -9>1<. ::fLAIlf" 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.) V\O 15~What amount do you claim from the City of Dubuque? '''fSgg'7,~) Ro,,u'1cL-l:o t/.bOOO.Q.2 +01" ilA.fla3:fd e.!€.C<j..li.la-tl,,-bilis a"GI- Jcdool1.. -to pai"d- u.t,'It'" ROOM. t /00(2... 16. Why do you claim the City of Dubuque is responsible? . .~ 'I~~I \ ~a ~r~ c.allf~ ~R~:';~t d0:. ~-{ ,~ t' +0 !\cpocl- fA}a~~ IZl<Vl.IIIVt~ ; _' 'Lt__. Ik... lu ~ __l___je~f.L.h,_ oj. S , Iff+ ~ .^'S5~~ '2-ht-/;,,,t, tt,'c pf!.oblfvVl l'ltf!. ,^u,,,-t -I- pkOl<\t. .#-. No (')111 Rd:14I0lfJ. 1-1,,,- call 'f--tk<..~H::1: dfpJ:. 5ho\0u;l up 'a.f-hl'. -I:k" str<.Vi-t C!lVU,(," Cl,,-O -HtL pol'Cf af'lZt'uEd) Q-c app!<o.,c. 5f''''' :t-f 17. Have you made any claim against anyone else for damages as a result of -I:kt'1 [,,4cl r<.'c$po,^rJ.~d. h. . 'd t?(lf' d dd ) 500P,Ef-+Cl~C<SSEa. t IS Incl en. yes, give name an a ress.HcL W!lh.!'. 60H.S fo \\0 --tlARi'1 alE. l'iAai/l\ oft- without- dff4'-{, -t\<.is vJ~o([ '/'Ab5 too./J ~A0f bt,,, 18. If the answer to Question 17 is yes, have you received any payment from that o.lio,du! I source, and if so, in what amount? R~ Dated this d.::;' - day of ~-t:f.M..- d ~ (Signature) C<r,d:t';<1-- L--.!-It,,f<tL (Print Name) J'u/t ~ -, ":J J~ ,20~. "S -\-C>.L'Q.u 'Tt t- H e. ., \Jt. OR.\~;",C(116 h;f'.~d J<il.n~tJo "PlZofESSI~IAQ( Srrq;;ctS -\-0 ~ Il'H\. A~ttr<. -rkE l\.lt~\t Ot 'J",<cl"JOi -+tIE'} 0\ I'cl~ 'f ~oVl,\.l +0 GEt;'" c IEcu, - Vip +ill :SlA!ca- 1:0 (for<-- I hOLU<.J i J, I~ a. pOO (<. to b I 0, ~Ici vJ b<? ESe It Ed Llf r o( to ~OIM.[ V\.t'l+ 0"- 'J().I~ 1/(, So WE fZ'i.rl~Cfd -r(HH' witt, SfRVICc~""Qstt~ offilE kt~ CtfJ-, who ((lOUt OIA fRI. JLd'J-- H -.+. ~o..\J( ltS -HI€- hEll" WE V\.~'<C(EC(. 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'-t +0 pR"f'c<l1.'i foR. ('~'U" ''''r .;). t""pll: y.... .y/2. kc " 7 d-f'\0pll: < 31.rL ~ (D - t'\'<.,,,,-oVl CQI1.p,-I''<-puct . d f'oP\ t " ~ k = 10 . K"","Vt bQSl60 a.rd."'looSt .(., k I ~'iRSO'-)" 3M. = ?, - wa.(\ papeR.. /Z.'CFo',o<' c~.(<, do>::> hOt ; "C\ll.v\'i Q"''ct R\'QSStw.~11 +-:Mt-) +t+ k. 'f tiS =1,('(,0 td:JOf... - CCllZ.ptlc r..lrlo.Ct\l,C~v,+ E..:,t ,wh I\i\{\\ IJJO(<..(( cS+=,,~ SER.\J I Ct fvto.shR- b; l( - -\-Ioo~ fX'1~\.t -tore. cd-: I i'kj ROOVV\ - WiAllpClfl'i<. St'''h f'tPClIIC - t(Z'(aJ w....,\1 - SE"i<.S r/<.o-~f(.l'1A - Sp<Qi<\:R-S 'fd- - fliO\lo.H!2. - 3(1..MSO.\;tL (r"iCMf,\.t h1t - \1l.J,I'i.S bO,tJl,'",~ shot:') -Chfl-ISrf\A.Qs II1!"kt:::. - C~f.d to-bib y..:)... '- th f1.0(JJ /<'UtS X b - f!-O\>\&\.I:l \iJooclElt +(A6[~ - wood tie. \'LQd boC\rcd.. (f>ot\JO<l.R.~1 -\,iZ...VIl <- sla.ts 1J, :)07 'f, 4-J... :ft 8'QSoc, ${, d i?3 55 ~ 17.0'1 $ II. '14 11 <fOO.?2 $; 00 d.OO, .- 11 7j. 0,0 11 06 d5. .- n 00 40.- jJ 7009 :fJ I 00 100 - .it d. S-,~ if 00 50- c4 52151. ServiciilAsT~ll \\"lean> '..,Vj //_'@ . Master of the Key City ServIce 1845 Washington St. Dubuque,IA 52001-3662 (563) 557-1488 Invoice ~-.INVOICE # l 7~ 1119292 ..J BILL TO SHIP TO Hellkle Rl:sidenc~ /700 Oak Crest Drive . >001 Dubuque, [A 5~ . NO. TERMS P.O. - -- . "^--- ,.-.-- QTY RATE DESCRIPTION , "-,, Call/Water Damage Lmcrgcnc~ Scn leI; ,. 1-:quipmC111 RCJ11<l,1 h Sl'lle/l,neal/School Du uquc, , I I I _.I -~ , - .- IJ Scnlccl\.'1askr oflhc Kc) Cit)! ] lave a great day! I'hdllK )llU lUI ChllO~llle' - -. --2-0(JIJO 6500 7.00o( , I I ~ ~I Total l -l I . ~--"-'---------, PROJECT AMOUNT 2000ln 6.'UH)] 1 &55 I , $2&~_.,:_~J PROPOSAL SEE PAYMENT TERMS BELOW Page: Floor Show Companies 1475 Associates Dr Dubuque, IA 52002 (563) 557-9952 ORDER NUMBER: 0017014 ORDER DATE: 7/20/2006 SALESPERSON: JFN CUSTOMER NO: OO-HENKCYN SOLD TO: Henkel, Cynthia 2766 Oak Crest Drive Dubuque, IA 52001 582-7194 SHIP TO: Henkel, Cynthia 2766 Oak Crest Drive Dubuque, IA 5200 I CONFIRM TO: CUSTOMER P.O. CARPET ITEM NUMBER TERMS 1/2 down,balance on completion UNIT QUANTITY 0.000 PRICE AMOUNT NOTES EACH Furnish & install carpet in basement in 2 rooms. Carpet removed due to water damage. APPLEGATE 2 SHAW Applegate 15' Style# 7E540 Color# ***** SQFT 708.750 2.40 1,701.00 15 * 47'3" PAD 7/16" MAGIC SQFT Stock 7/16" Magic Pad (270 SF Per Roll) ***** 708.750 0.76 538.65 LABOR EACH Furnish & Install - Flooring Install-$574.09 Removal of steps $18.90 Step Charge - $85.00 1.000 677.99 677.99 TAX Sales Tax EACH 1.000 156.78 156.78 Net Order: 3,074.42 Freight: 0.00 Sales Tax: 0.00 Order Total: 3,074.42 'roposal Page No. of Pages LLOYD P. LUBER General Contractor 1629 Prescott Street Dubuque, Iowa 52001 Phone 583.3126 PHONE DATE ~.1- ac' STREET JOB NAME JOB LOCATION !;;:J...(:() ARCHITECT We hereby submit specifications and estimates for: _Z:L.~.~~~~~W w~....dw~W..~.~I~ 3Y" ~ -zVk ....;&~~.....w.~...... .~.........~../....../59.....~...4t"... ~W..~......~ me propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: <10 dollars ($ R<?:" - ). All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance Our workers are fully covered by Workman's Compensation Insurance. Authorized '--/ ~ Signature ~ ~ Note: This proposal may be withdrawn by us if not accepted within roo days. Date of Acceptance: Signature Acceptance of 'roposal-- The above p,;ces, spec;t;caboos and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. State Farm Insurance Companies@ STATI FARM Iii) ~ INSURANCE @ July 3, 2006 Lincoln Operations Center Fire Claims Central P.O. Box 82539 Lincoln, NE 68501-2539 888429 5077 Fax 888 429 5076 CYNTHIA HENKEL 2766 OAKCREST DRIVE DUBUQUE IA 52001-0923 RE: Claim Number: 15-E090-510 Date of Loss: June 30, 2006 Dear Ms. Henkel: This is a follow-up to our telephone conversation on Saturday, July 1, 2006; regarding the water damage to the basement of your home. As discussed in our conversation, the cause of the damage is off your primary residence, and there are exclusions which apply under the Losses Not Insured section of your Homeowners Policy. Please refer to the following policy language: SECTION I - LOSSES NOT INSURED 2. We do not insure under any coverage for any loss which would not have occurred in the absence of one or more of the following excluded events. We do not insure for such loss regardless of: (a) the cause of the excluded event; or (b) other causes of the loss; or (c) whether other causes acted concurrently or in any sequence with the excluded event to produce the loss; or (d) whether the event occurs suddenly or gradually, involves isolated or widespread damage, arises from natural or external forces, or occurs as a result of any combination of these: c. Water Damage, meaning: (1) flood, surface water, waves, tidal water, tsunami, seiche, overflow of a body of water, or spray from any of these, all whether driven by wind or not; (2) water or sewage from outside the residence premises plumbing system that enters through sewers or drains, or water which enters into and overflows from within a sump pump, sump pump well or any other system designed to remove subsurface water which is drained from the foundation area; or HOME OFFICES. BLOOMINGTON, IlliNOIS 61710-0001 CYNTHIA HENKEL 15-E090-510 Page 2 July 3, 2006 (3) water below the surface of the ground, including water which exerts pressure on, or seeps or leaks through a building, sidewalk, driveway, foundation, swimming pool or other structure. However, we do insure for any direct loss by fire, explosion or theft resulting from water damage, provided the resulting loss is itself a Loss Insured. Although we are unable to provide coverage for your claim, we hope we have handled your claim in a prompt, courteous, and professional manner. We understand you do have a choice when it comes to your Homeowners insurance. We appreciate the fact that you have chosen State Farm@ to be your insurance carrier. If you have any questions regarding your claim or any additional information you would like us to consider, please contact our office. Our office hours are 7:00 a.m. to 7:00 p.m., Monday through Friday, and 8:30 a.m. to 5:00 p.m., Saturday. Sincerely, ~~ Rachel Hahn ~ Claim Representative Team 3 888 429 5077 State Farm Fire and Casualty Company 08/875/0703007 cc: 15-3201 Dennis Baumhouer Use Your:;;;,~;iijii..\ 2 % BIG CARD?";' REBA TE @ 5300 Dodge Street Dubuque. IA 52003 11111111111111111111111111111111111111111111 ..t:\;4<\cloof1- ~ 1 K Sale Transaction P-oDV'-f~"'" LIGHT GRAY LATX FLOO 5507113 15.97 TOTAL TAX AT 7% TOTAL SALE VISA 0739 022198 EXP: 05/08 15.97 1.12 17.09 17.09 TOTAL NUMBER OF ITEMS = 1 Summer Seasonal Merchandise wi" be refunded at the register price on the day of the return or the price listed on your receipt - whichever is LOWER. Returns of Summer Seasonal Merchandise will only be accepted if the product is unused and in the original packaging. Returns of Summer Seasonal Merchandise will not be accepted at all after September 1st. THANK YOU, YOUR CASHIER, Andrew 89736 08 3166 07/22/06 02:36PM 3057 WAL*MART' ALWAYS LOW PRIOES. ,,'<k\\O<l.~t\'-\(L II/~' V-J \ "'t~(). ~ 5 't "IN\- WE SELL FOR LESS MANAGER ROBERT HARDING ( 563 ) 582 - 1003 ST' 2004 OPt 00004677 TE' 07 TR' 05234 WP SEAM SLR 002666508936 6 AT 1 FOR 1.86 SUBTOTAL TAX 1 7.000 X TOTAL VISA TEND 11.16 X 11.16 0.78 11.94 11.94 ACCOUNT .0739 APPROVAL .019276 TRANS 10 -0176200829527279 VALIDATION -XJVM PAYMENT SERVICE - E CHANGE DUE 0.00 I ITEMS SOLD 6 TC' 0860 8284 4180 3087 5468 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 Purch.., .11 your BTS need. with. UM 81ft c.rd. 07/19/06 18:02:41 ...CUSTOMER COPY... IJirtt.,e. R E C cd j ";}' a.+ -f.,oi:- Q-t s-/--R',t2-S 1O.1oIld~~ S~\Okl<; flood CP..'<.S+. n )~ """( , -l ~ ..:j '- . 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