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.)
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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?
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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.)
V\O
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 -I:kt'1 [,,4cl r<.'c$po,^rJ.~d.
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source, and if so, in what amount?
R~
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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 - $85.00
1.000
677.99
677.99
TAX
Sales Tax
EACH
1.000 156.78 156.78
Net Order: 3,074.42
Freight: 0.00
Sales Tax: 0.00
Order Total: 3,074.42
'roposal
Page No.
of
Pages
LLOYD P. LUBER
General Contractor
1629 Prescott Street Dubuque, Iowa 52001
Phone 583.3126
PHONE
DATE
~.1-
ac'
STREET
JOB NAME
JOB LOCATION
!;;:J...(:()
ARCHITECT
We hereby submit specifications and estimates for:
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w~....dw~W..~.~I~
3Y" ~ -zVk
....;&~~.....w.~......
.~.........~../....../59.....~...4t"...
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me propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
<10
dollars ($ 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
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