Claim by Vernon Puls, Joan PulsMasterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MIH,MORANDLM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: June 19, 2013
RE: Claim Against the City of Dubuque by Vernon & Joan Puls
Claimant Date of Claim Date of Loss Nature of Claim
Vernon & Joan Puls 06/17/13 04/18/13 Property Damage
This is a claim in which claimant alleges that sewer water backed up into claimants'
basement after a city sewer was plugged.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
John Klostermann, Street & Sewer Maintenance Supervisor
Vernon & Joan Puls
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001 -6944
TELEPHONE (563) 583 -4113 / FAx (563) 583 -1040 / EMAIL tsteckle @cityofdubuque.org
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: c&v, \-\ -P
2. Address: to to t\k vv.\ Nt\ is\ \) , T r))1 (hch
3. Telephone Number:
4. Date of Incident: pi v'N , ..q
5. Time of Incident: c)
6. Location of Incident (Be specific):
Vr."1 LJ
(\ c.') 'HI C
'pn A
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.)
s, v.„:„ Vk kl■ \NN st_.
8. What were weather conditions like? Q \I\
9. Give name and address of any witnesses:
'\) N., CO"
10. Did Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.)
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.)
Lk/ ` 1 �. A4, 1. -.t , C "
15. What amount do you claim from the City of Dubuque?
10
16. Why do you claim the City of Dubuque is responsible? -t\t,
cJ
A.-10C\ VA �n �� � L fl w � a \\ e °M p yy ,1\ ' 1 M n UO,r-
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
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
day of , 20
(Signa ure)
7„, e k, „ \, Ve-x-1201 [=, )(S
(Print Name)
0
w
0 c7
C 0 m
`s — x
0 m m
> . 0
Losses
(1) King size bed, complete
(1) King size mattress pad
(1) King size fitted sheet
(1) King size blanket
(1) King size bedspread
(1) Queen size mattress pad
(1) Queen size fitted sheet
(1) Queen size blanket
(1)Queen size bedspread
(3) Twin size beds, complete
(1) Queen size 4" memory foam topper
(1) Carpet
(1) Padded chair
(4) Padded kitchen chairs
(2) Chest of drawers
(1) Clothes rack
(1) Floor fan
(1) Brass and glass floor lamp
(1) Chair pad
Miscellaneous
(1) Skilsaw
(2) Wood night tables and table covers
(1) Lawn chair
(1) Carpeting, 11' x 18'
(1) Clothing rack
(1) Lamp
(1) Electric drill
(1) Hip waders
Charlie Leppert - Replace basement steps carpet runner
(1) Dehumidifier - \' . ' ---
(1) Wood TV stand - Goodwill
(1) Shop Vac —(1) Dirt Devil Hand Vac -Ace Hardware
(1) 3'x20' Carpet runner for basement stairs - Menards
Furnace and water heater -All Seasons Heating and Cooling
Lawn mower repair (covered with 2' of sewer water) McGovern's
Mr. Rooter
Washer and dryer -Ellis Appliance
Servpro
Bathroom vanity - Menards
Miner Plumbing
Friedman Construction
$ 870
$25
$ 13
$ 25
$ 60
$25
$ 13
$ 25
$3
$ 1110
$ 125
$200
$15
$ 100
$ 50
$1
$ 17
$ 50
$15
$350
$ 100
$50
$5
$ 200
$1
$ 18
$ 50
$ 30
$149.84 (Receipt enclosed)
$ 10 (Receipt enclosed)
$ 94.14 (Receipt enclosed)
$ 61.60 (Receipt enclosed)
$3600 (Invoice enclosed)
$77.49 (Invoice enclosed)
$530.59 (Invoice enclosed)
$1174.86 (Invoice enclosed)
$3800.00 (Invoice enclosed)
$754.34 (invoice enclosed)
$826.90 (Invoice enclosed)
$298.10 (Invoice enclosed)