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Nowata Street final acceptance D'i:i~~E ~ck~ MEMORANDUM November 15, 2006 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Nowata Street Reconstruction Project CIP 3001719: Fiscal Year 2006 Street Construction Program City Engineer Gus Psihoyos is recommending acceptance of the Nowata Street Reconstruction Project, as completed by McDermott Excavating, Inc., in the final contract amount of $352,920.18, which is a 4.7% increase over the original contract in the amount of $337,082.33 due to an overage in project quantities and 12 change orders. It is further recommended that the City Council adopt the Final Schedule of Assessments in the amount of $63,401.99. I concur with the recommendation and respectfully request Mayor and City Council approval. (l2lv1 ~t(l~ Mich'ael C. Van Milligen MCVM/jh Attachment cc: Barry Lindahl, City Attorney Cindy Steinhauser, Assistant City Manager Gus Psihoyos, City Engineer ,j ., D'G~~E ~ck~ MEMORANDUM November 14, 2006 FROM: Michael C. Van Milligen, City Manager Gus Psi hoyos, City Engineer ~Q TO: SUBJECT: Nowata Street Reconstruction Project CIP 3001719: Fiscal Year 2006 Street Construction Program INTRODUCTION The enclosed resolutions provide for the acceptance of the construction contract and the establishment of the Final Schedule of Assessments for the Nowata Street Reconstruction Project. BACKGROUND The Nowata Street Reconstruction Project provided for the complete reconstruction of all underground utilities, roadway sub-base and mainline concrete pavement between University Avenue and Loras Boulevard. Nowata Street changed from a 27-foot wide street to a 37-foot wide roadway that accommodates parking on both sides of the street. The additional parking provides for alternate parking options for users of the adjacent Allison-Henderson Park and improves parking congestion concerns for local residents. The Nowata Street project incorporated traffic-calming measures of two roadway bump- outs at both the University Avenue and Loras Boulevard intersections. The bump-out design reduces the street width from 37 feet to 31 feet at both ends of the project to aid in the reduction of traffic speeds. The reconstructed storm sewer system incorporated larger capacity storm water intakes with new 1S-inch diameter sewer pipe that improves the storm water conveyance in the area. The existing sanitary sewer system was completely upgraded to include a new 8- inch mainline sewer; the reconstruction of deteriorated brick manholes; and the replacement of all private sanitary sewer laterals. The watermain system was a complete reconstruction that included new mainline water, water services, valves and fire hydrants. The project provided for the installation of fiber optics and telecommunications conduit infrastructure and the complete reconstruction of the existing pedestrian sidewalks along the east side of Nowata Street between University Avenue and Loras Boulevard. New sidewalk was constructed along the Allison-Henderson Park side. DISCUSSION The Nowata Street Reconstruction Project has been completed by McDermott Excavating, Inc. of Dubuque, Iowa in the final contract amount of $352,920.18, which is a 4.7% increase from the original contract in the amount of $337,082.33. The reason for the $15,838 increase in contract cost resulted from an overage in project quantities. In addition, there were 12 change orders on the project that accounted for $10,537. These change orders varied from the original project scope and included such items as: additional water main work, additional storm sewer work and constructing 8" concrete pavement. RECOMMENDATION I recommend that the City Council accept the improvements, establish the final contract at $352,920.18 and adopt the Final Schedule of Assessments in the amount of $63,401.99 BUDGET IMPACT The project cost summary for the Nowata Street Reconstruction Project is as follows: Estimate Award Final Construction Contract $363,921.48 $337,082.33 $352,920.18 Contingency 36,392.15 36,392.15 0 Construction Engineering & Inspection 60,047.04 60,047.04 66,774.26 Total Project Cost ~460.360.67 ~433,521.52 ~419,694.44 The project funding summary is as follows: CIP No. Fund Description 3001719 FY 2006 Street Construction Program Special Assessment - Street Improvement, City Properties Special Assessment - Street Improvement, Commercial Properties Special Assessment - Street Improvement, Residential Properties Special Assessment - Sanitary Laterals, Residential Properties 7401405 Watermain Replacement Program 7101638 Street Program Related Sanitary Sewer Improvements 7201066 Storm Sewer General Repairs 1021017 Fiber Optic Conduit - Paving Projects Total Project Funding Fund Amount $234,479.68 29,180.25 3,418.45 19,255.68 11,547.61 56,851.59 39,918.99 7,609.48 17,432.71 $419.694.44 The Nowata Street Reconstruction Project will be funded through the annual capital improvement project appropriation of City funds as noted above in the amount of $121,812.77. The project, as outlined, will require Special Assessments to all residential and commercial properties in the amount of $34,221.74. The Special Assessment share for City owned properties in the amount of $29,180.25 will be funded through expenditure from the Annual Street Construction Program (funded through the Local Option Sales Tax) in the amount of $263,659.93. SPECIAL ASSESSMENTS Based upon final construction costs, the total amount of special assessments for all associated improvement (including street pavement and sanitary service laterals) is in the amount of $63,401.99, which is 15.0% ($74,593.23) below the preliminary special assessments estimates that were presented to the property owners and approved at the project public hearing. The reason for the reduction in the total amount of special assessment was a result of the project cost as it relates to sanitary sewer laterals (estimated cost of $46 per lineal foot versus the actual cost of $32 per lineal foot). FINANCIAL ASSISTANCE Property owners subject to street improvement and sanitary sewer lateral assessments may be eligible for the City's low and moderate income special assessments assistance program, ranging from 20% to 100% of the assessments for the owner-occupied residential property depending on family size and income level. To allow sufficient administrative time to process financial assistance applications for low- to moderate-income families, eligible property owners will be given approximately 30 days from the date of mailing the Notice of Filing the Final Schedule of Assessments to apply for financial assistance that may reduce the amount of the assessment payable by the property owner. During this 30 day period, assessments may be paid in full or in part without interest at the City of Dubuque, Office of the City Treasurer. After approximately 30 days, any unpaid assessment will be levied against said benefited property with the Dubuque County Treasurer and will be payable in 10 annual installments at the County Treasurer's Office, and will draw annual interest at nine percent (9%). FINAL ASSESSMENT SCHEDULE The schedule for the Final Assessment process is as follows: Council Approve Final Schedule of Assessments Mail Final Special Assessment Notice to Property Owners Mail Financial Assistance Information to Property Owners Publish Notice of Final Assessment 1 st Publication: 2nd Publication: Deadline for Financial Assistance Applications Deadline for Paying Assessment to City, Without Interest Deadline for Unpaid Assessment, Levy with County Treasure November 20, 2006 November 27, 2006 November 27,2006 November 24, 2006 December 1, 2006 December 27,2006 December 27, 2006 December 27,2006 ACTION TO BE TAKEN The City Council is requested to adopt the attached resolutions accepting the improvements, establishing the final contract amount, and approving the Final Schedule of Assessments for the Nowata Street Reconstruction Project. Prepared by Greg Doeden, Civil Engineer cc: Dawn Lang, Budget Director Jenny Larson, Budget Director Ken TeKippe, Finance Director Bob Green, Water Plant Manager Don Vogt, Public Works Director Robert Schiesl, Assistant City Engineer Jon Dienst, Civil Engineer RESOLUTION NO. 550-06 ACCEPTING THE NOWATA STREET RECONSTRUCTION PROJECT Whereas, the contract for the Nowata Street Reconstruction Project (the Project) has been completed and the City Manager has examined the work and filed a certificate stating that the Project has been completed according to the terms of the contract, plans and specifications and that the City Manager recommends that the Project be accepted. NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA: Section 1. The recommendation of the City Manager is approved and the Project is hereby accepted. Section 2. The City Treasurer is hereby directed to pay to the contractor from the Street Construction Fund, Watermain Replacement Fund, Street Program Related Sanitary Sewer Improvements Fund, Storm Sewer General Repairs Fund, and the Fiber Optic Conduit - Paving Projects Fund appropriations for the contract amount of $352,920.18 less any retained percentage provided for therein as provided in Iowa Code chapter 573, and to pay such retainage only in accordance with the provisions of Iowa Code chapter 573. Passed, approved and adopted this 20th day of November, 2006. Roy D. Buol, Mayor Attest: Jeanne F. Schneider, CMC, City Clerk RESOLUTION NO. 551-06 FINAL ESTIMATE Whereas, the contract for the Nowata Street Reconstruction Project has been completed and the City Engineer has submitted his final estimate showing the cost thereof including the cost of estimates, notices and inspection and all miscellaneous costs. NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE,IOWA: Section 1. That the cost of said improvement is hereby determined to be $419,694.44 and the said amount shall be paid from the Street Construction Fund, Watermain Replacement Fund, Street Program Related Sanitary Sewer Improvements Fund, Storm Sewer General Repairs Fund, and the Fiber Optic Conduit - Paving Projects Fund of the City of Dubuque, Iowa. Section 2. That $34,221.74 of the cost thereof shall be assessable upon private and commercial benefited properties and $263,659.93 shall be paid from the Street Construction Fund, $56,851.59 from the Watermain Replacement Fund, $39,918.99 from the Street Program Related Sanitary Sewer Improvements Fund, $7,609.48 from the Storm Sewer General Repairs Fund, and $17,432.71 from the Fiber Optic Conduit - Paving Projects Fund. Passed, approved and adopted this 20th day of November, 2006. Roy D. Buol, Mayor Attest: Jeanne F. Schneider, City Clerk f)U Y D. Buol, Mayor Attest: anne F. Schneider, CMC, City Clerk City of Dubuque - Engineering Division Final Payment Form PAYMENT NO, COUNCIL FINAL DATE: November 14, 2006 PROJECT NAME: NOWATA STREET RECONSTRUCTION CONTRACTOR: McDERMOTT EXCAVATING CONTRACT AMOUNT: $337,082.33 BID ITEM DESCRIPTION UNIT COST 1 Clearing & Grubbing 18" to 24" Each 1.00 $ 550.00 2 Remove Pavement SY 2,514.00 $ 8,245.92 3 Remove Existing Storm Intake Each 2.00 $ 500.00 4 Abandon Existing Pipe CY 6.00 $ 540.00 5 Remove Existing Sanitary Manhole Each 3.00 $ 690.00 6 Abandon Water Vault Each 1.00 $ 200.00 7 Remove Water Vault 1.00 $ 200.00 _!!~n!llll- .-....- Ill' ~'__.IIIII_.I 8 Excavation, Unclassified 1,572.00 $ 7,624.20 9 Backfill, Limestone 4,267.03 $ 20,268.39 10 Backfill. Topsoil 1.415.16 $ 2,901.08 11 Granular Stone Base Ton 1,088.39 $ 12,810.35 12 3" Crushed Stone Base Ton 2.764.02 $ 31,979.71 13 Trench Stabilization Stone Ton $12.75 0.00 $ II.~~_III!II"""""'-- 14 PC Concrete Pavement, (7") w/lnte9ral Curb. Class "CO SY $24.99 3,378.03 $ 84.416.97 15 Fixture Adjustment EA $178.50 13.00 $ 2,320.50 16 PC Concrete Driveway, 6", Remove & Construct SY $43.72 140.61 $ 6,147.47 17 PC Concrete Sktewalk, 4", Remove & Construct SF $3.75 6,475.78 $ 24,284.18 18 PC Concrete Sidewalk, 6", Remove & Construct SF $4.40 1,024.88 $ 4,509.47 19 PC Concrete Sktewalk, 8", Reinforced, Remove & Construct SF $5.31 101.42 $ 538.54 20 PC Concrete Steps, Remove & Construct Each $1,680.00 2.00 $ 3,360.00 21 PC Concrete Access Ramp, Detectable Each $165.00 5.00 $ 825.00 22 6" Subdrain, Perforated Plastic Drain Tile 1 , 23 Intake 104-B Each $2.100.00 2.00 $ 4,200.00 24 Manhole 48" Diameter, Complete Each $1,375.00 1.00 $ 1,375.00 25 Storm Sewer. 18" RCP, CL III LF $28.06 148.00 $ 4,152.88 m1~~~ Storm Water Curb OpeninQ Neenah R-3262-3 Each $95.00 2.00 $ 190.00 ~.II~IlIIlII, ~i.IlIIlIII_~I~11I1I 1IIII_1I11~~.IlIIlIJI_,_... 27 8" PVC w.llnitial Backfill LF $21.95 677.00 $ 14.860.15 28 48" Diameter Manhole Base Each $350.00 3.00 $ 1,050.00 29 48" Diameter Manhole Sidewall VF $88.00 29.02 $ 2,553.76 30 Manhole Frame & Cover Each $290.00 3.00 $ 870.00 31 4" PVC Lateral w.llni!ial Backfill LF $18.40 307.00 $ 5,648.80 32 8"x4" PVC Wye Each $68.00 12.00 $ 816.00 33 Locate Exist~/Exploration Each $100.00 12.00 $ 1,200.00 ~"'__________~"W'II h"')III~.11111IlIIlIIlII rTT"ll 34 4" Valve MJ w/Box Each $497.00 1.00 $ 497.00 35 4" MJ Cap Each $60.00 0.00 $ 36 4" DIP, Class 52 LF $24.22 50.00 $ 37 6" - 441 Sleeve Each $222.00 2.00 $ 38 6" Valve MJ w/Box Each $613.00 1.00 $ 39 6" Mega Lug MJ Each $50.00 2.00 $ 40 6" MJ Cap Each $72.00 0.00 $ 41 6"X6" Anchoring Tee MJ Each $235.00 1.00 $ 42 6" DIP, Class 52 LF $25.35 20.83 $ 43 Hydrant MJ Each $1,755.00 1.00 $ 44 8" Valve MJ w/Box Each $864.00 4.00 $ 45 8"X4" Anchoring Tee MJ Each $240.00 1.00 $ 46 8"X6" Anchoring Tee MJ Each $275.00 1.00 $ 47 8"X6" Reducer MJ Each $130.00 1.00 $ 48 8" DIP. Class 52 LF $33.05 814.00 $ 49 10"X8" Anchoring Tee MJ Each $367.00 1.00 $ 1,211.00 444.00 613.00 100.00 235.00 528.04 1,755.00 3,456.00 240.00 275.00 130.00 26,902.70 367.00 50 10" - 441 Sleeve Each $283.00 2.00 $ 566.00 51 3/4" Copper Service Line TYPE K LF $10.63 167.00 $ 1,775.21 52 Water Service Lines Stop Box, Tap Installation 3/4" Each $446.00 10.00 $ 4,460.00 53";,~"::'~~=~~~;~'=m"'m"w"""""'~"",,",,,'"'''''''_'''''''''N'''N"''''' Each j $50.00 0.00.. $ . .1IIIIIII!IRU____IIlII.IlII_IIlIIIlII~III_IJ__III..... 54 Conduit, 4" PVC Sch 40 wfTrace Wire LF $10.53 768.00 $ 8,087.04 55 Conduit, 4" PVC Sch 80 wfTrace Wire LF $11.91 103.00 $ 1,226.73 56 Pull Box, Standard, 17"X30" Each $720.00 2.00 $ 1,440.00 57 Fiber Optics Junction Vault, 48 Inch Diameter, Precast Concrete Each $3,425.00 1.00 $ 3,425.00 _--_I_~_IIIlIII._IIIII_ 58 Sawcut. Concrete LF $3.50 95.80 $ 335.30 59 Sod SY $7.35 795.00 $ 5,843.25 60 Seed SY $2.10 943.77 $ 1,981.92 61 Tree Preservation Measures LS $500.00 0.50 $ 250.00 62 Dust Control Surface Treatment STA $100.00 0.00 $ 63 Erosion Control Plan - Operating Procedures LS $3,700.00 1.00 $ 64 Traffic Control & Safety Control LS $11,700.00 1.00 $ TOTAL AMOUNT EARNED TO DATE - BASE BID: I $ 3,700.00 11,700.00 342.382,86 I ~1JJIl_-III.IUII"___IlIIIlII........ml.___1lIIIlII1lIIIlII 400.00 1,274.33 6,380.88 1.046.85 392.50 650.00 485.00 100.00 67.00 260.77 86.00 192.00 Furnish & Install 3/4" Curb Slops LS $ 400.00 1 $ PCC Pavement, 8" Class "C" (Patch at University Ave.) SY $ 47.25 26.97 $ PCC Pavement, 8" Class "M4" (Patch at Loras Blvd.) SY $ 51.97 122.78 $ Lost Time Due to Incorrect Grades LS $ 1,046.85 1 $ Tie-in Exist. Sump Lines at 1250 &1290 Nowata 5t. to 6" U.D. LS $ 392.50 1 $ Re-grade and Form Walk at NE Cor of Nowata & University LS $ 650.00 1 $ Raise Storm Manhole LS $ 485.00 1 $ Remove and Replant Tree in Park LS $ 100.00 1 $ Relay Brick Pavers at 1250 Nowata LS $ 67.00 1 $ 10" DIP, Class 52 LF $ 36.42 7 $ 4" Mega Lug MJ Each $ 43.00 2 $ 8" - 22 1/2 Degree Bend Each $ 192.00 1 $ Tree Damage LS $ 798.00 $ TOTAL AMOUNT EARNED TO DATE. CHANGE ORDERS: I $ TOTAL AMOUNT EARNED TO DATE: 1$ TOTAL DUE CONTRACTOR: Construction Engineering & Inspection TOTAL CONSTRUCTION COST: CERTIFICATE OF THE CITY MANAGER: 798.00 10.537.33 I 352.920.18 I $352.920,18 I $66.774,26 I $419.694,44 I hereby certify that the above statement shows in detail the correct amount of all work required to complete the above improvement. APPROVED: CERTIFICATE OF THE CONTRACTOR: The undersigned, McDERMOTT EXCAVATING contractor for the above improvement. does hereby accept the above nT otal Due Contractor", as full settlement for all claims for said improvement. CONTRACTOR: BY: TITLE: DATE: 11f~L1R~~ C.-MC,-!""s hac- . ...s:-<-p.e,,- v l '.>0;- iI /'1-0(., RESOLUTION NO. 552-06 RESOLUTION APPROVING THE FINAL SCHEDULE OF ASSESSMENTS NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA: That the attached sheet(s), Page 1 to Page 1 inclusive, is hereby determined to be the Final Schedule of Assessments for the Nowata Street Reconstruction Project and the valuations set out herein are hereby approved. Passed, approved and adopted this 20th day of November ,2006. Roy D. Buol, Mayor Attest: Jeanne F. Schneider, City Clerk v Q '" < >", w ~ ~ z 5~ ~ '" "'''' ~ ill <(g~:g ~~~~ ~ ~ ~ ':!" :.%00: g~~:H l:lI-<::::l~ B~:;;!~ ~~~~ ~~~~ C3~5~ j:"fil wz ~~ In:;;! ~~ <~ ~ z . c .Q ~ ~ o " U C . :Q ~ u . . . c .. o . U ~ ~ o o D B U ~ o o o "- C , o E . . " ~ . . ~ "8, B ~ ~ .!: ~ c ~ !.5 ~ , .0 c'O ~~ ~u ~~ .~ '0 ~g . , 00 ~u ~~ .u ~:S . ~ OD ~~ -g~ &;;: eo o. lLQ ~~ o ~ ~ 2 .- B:s ~ Xl "E -g ~~ UD ~. DO .~ . . ~ . . . 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" ;:i "! ~ '" M NOTICE OF FILING OF THE FINAL SCHEDULE OF ASSESSMENTS AGAINST BENEFITED PROPERTIES FOR THE NOWATA STREET RECONSTRUCTION PROJECT WITHIN THE CITY OF DUBUQUE, IOWA TO THE PERSONS OWNING LAND LOCATED WITHIN THE DISTRICT DESCRIBED AS NOWATA STREET RECONSTRUCTION PROJECT WITHIN THE CITY OF DUBUQUE, IOWA: The improvement type(s) and the location(s) is (are) as follows: Nowata Street (Between University Avenue and Loras Boulevard) Consisting of the properties which are described as follows: All property included with the areas described so as to include one-half of the privately owned property between each such street to be improved and the next street, whether such privately owned property situated more than 300 feet from the street to be improved be assessed. You are hereby notified that the Final Schedule of Assessments against benefited properties within the District described as the Nowata Street Reconstruction Project has been adopted and assessments confirmed by the City Council of Dubuque, Iowa, and that said schedule of assessments has been certified to the Dubuque County Treasurer of Dubuque County, Iowa. YOU ARE FURTHER NOTIFIED THAT ASSESSMENTS MAY BE PAID IN FULL OR IN PART WITHOUT INTEREST AT THE OFFICE OF THE CITY TREASURER, CITY HALL, 50 W. 13TH STREET, DUBUQUE, IOWA, 52001 AT ANY TIME WITHIN 30 DAYS AFTER THE DATE OF THIS LETTER. After 30 days, unpaid special assessments of $100.00 or more shall be levied against said benefited property with the Dubuque County Treasurer of Dubuque County, Iowa and will be payable in 10 annual installments at the County Treasurer's Office, and will draw annual interest at nine percent (9%) computed to the December 1st next following the due dates of the respective installments as provided in Section 384.65 of the Code of Iowa. Each installment will be delinquent from October 1 following its due date on July 1st of each year. Property owners may elect to pay any annual installment semiannually in advance. All properties located within the boundaries of the Nowata Street Reconstruction Project above described have been assessed for the cost of the making of said improvements, the amount of each assessment and the amount of any conditional deficiency assessment having been set out in the schedule of assessments accompanying the same, which are now on file in the office of the County Treasurer of Dubuque County, Iowa. For further information you are referred to said schedule of assessments. This Notice given by direction of the City Council of the City of Dubuque, Iowa, as provided in Section 384.60 of the Code of Iowa. Jeanne F. Schneider, CMC, City Clerk THE CITY OF ( I') i"I:;!! ()' if,: _...".... ..._~ _.J ---'" "'-_ \_._.. . __~ ~-------- City Clerk's Office 50 West 13th Street Dubuque, Iowa 52001-4864 (563) 589-4120 Office (563) 589-0890 Fax (563) 690-6678 roD www.cityofdubuque.org ~cIk-~ November 27, 2006 NOTICE OF FILING OF THE FINAL SCHEDULE OF ASSESSMENTS AGAINST BENEFITED PROPERTIES FOR THE NOWATA STREET RECONSTRUCTION PROJECT WITHIN THE CITY OF DUBUQUE, IOWA TO THE PERSONS OWNING LAND LOCATED WITHIN THE DISTRICT DESCRIBED AS NOWATA STREET RECONSTRUCTION PROJECT WITHIN THE CITY OF DUBUQUE, IOWA: The improvement type(s) and the location(s) is (are) as follows: Nowata Street (Between University Avenue and Loras Boulevard) Consisting of the properties which are described as follows: All property included with the areas described so as to include one-half of the privately owned property between each such street to be improved and the next street, whether such privately owned property situated more than 300 feet from the street to be improved be assessed. You are hereby notified that the Final Schedule of Assessments against benefited properties within the District described as the Nowata Street Reconstruction Project has been adopted and assessments confirmed by the City Council of Dubuque, Iowa, and that said schedule of assessments has been certified to the Dubuque County Treasurer of Dubuque County, Iowa. YOU ARE FURTHER NOTIFIED THAT ASSESSMENTS MAY BE PAID IN FULL OR IN PART WITHOUT INTEREST AT THE OFFICE OF THE CITY TREASURER, CITY HALL, 50 W. 13TH STREET, DUBUQUE, IOWA, 52001 AT ANY TIME WITHIN 30 DAYS AFTER THE DATE OF THIS LETTER. After 30 days, unpaid special assessments of $100.00 or more shall be levied against said benefited property with the Dubuque County Treasurer of Dubuque County, Iowa and will be payable in 10 annual installments at the County Treasurer's Office, and will draw annual interest at nine percent (9%) computed to the December 1st next following the due dates of the respective installments as provided in Section 384.65 of the Code of Iowa. Each installment will be delinquent from October 1 following its due date on July 1 st of each year. Property owners may elect to pay any annual installment semiannually in advance. Service People Integrity Responsibility Innovation Teamwork All properties located within the boundaries of the Nowata Street Reconstruction Project above described have been assessed for the cost of the making of said improvements, the amount of each assessment and the amount of any conditional deficiency assessment having been set out in the schedule of assessments accompanying the same, which are now on file in the office of the County Treasurer of Dubuque County, Iowa. For further information you are referred to said schedule of assessments. This Notice given by direction of the City Council of the City of Dubuque, Iowa, as provided in Section 384.60 of the Code of Iowa. ~4/;U~C4!r2~ ~;~ F. Schneider, CMC City Clerk Laser Mailing Labels Jam-Proof Use template CEG03218 Baal, Nicholas A. 1200 Nowata Dubuque, IA 52001 DeMuth, Mark R. & Kathryn L. 1350 Nowata Dubuque, IA 52001 Giese, James J. & Catherine E. 1020 Nowata Dubuque, IA 52001 Haase, C. Lawrence & Mary Jane 1495 University Dubuque, IA 52001 Heinz, Steven A. & Pamela J. 1150 Nowata Dubuque, IA 52001 Hoelscher, Larry G. & Jennifer Y. 1330 Nowata Dubuque, IA 52001 King, David M. & Mary J. 1290 Nowata Dubuque, IA 52001 Moldenhauer, Kerin Kae 1250 Nowata Dubuque, IA 52001 Mulgrew Oil Company Box 894 Dubuque, IA 52004-0894 Oswald, Louis J. & Rose E. 1080 Nowata Dubuque, IA 52001 Peterson, Gary D. & Lili M. 1220 Nowata Dubuque, IA 52001 Schremin, Kathleen Ann 1475 University Dubuque, IA 52001 Thoms, Erik T. & Christine R. 1120 Nowata Dubuque, IA 52001 ^Corporate I S I G N V~~~'M A T U R E 1.888.CE TODAY (238.6329) www.CorporateExpress.com and www.eway.com WOJ"^eMa"MMM pue WOJ"ssaJdX3a~eJodJoJ"MMM (6ZE9"8EZl AVaOl. 3)"888"L w,SS'a.dX3 ~ 3 l:l n 1 \;/ N 9 I S G:i,eJodJoJV Willman, Raymand F. & Phyllis A. 1485 University Dubuque, IA 52001 Willman, Raymand F. & Phyllis A. 1485 University Dubuque, IA 52001 8LZEO~3) a~eldwa~ asn ~OOJd-Wer slaql?"] 6u!l!eVII JaSel o '" " ~~ -'z "W g~ ~~ g~~ ~f2~~ :i~~! :::lZOw g~~lD lDc(:::l~ iS~;iiS ~~;::z ~~~~ o~5~ -0 >-w w:r Wu "'''' lnct ~~ ,,>- ~ z . ;; u o . .2 ii . . 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" ~ 0: 0: 0: m - N ~ N W ~ ~ ~ M -0 -0 -0 -0 -0 -0 -0 -0 -0 :g -0 ~ -0 :g -0 -0 -0 w :g -0 -0 -' -' -' -' -' -' -' -' -' -' z -' -' -' -' '" -' -' '" >' "" -' 0 -; . '" . e ~ ~ ~ . . 0 "' " " . ~ ~ 0; 0 0. ~ '" E . -; . ~ m .. .. " ~ . 0 "' .. . .. '" '" '" ~ ~ 0 ::J ::J ~ .0 '" '" 0. . 0 0 0: .. .. ~ u: .. .. 0 " 0 0 il. . u u . 0 .0 ~ .. c:i c:i 0 0 "" . . . '" 0 0 " ~ .. . . E E -; . .. 0 . . . '" '" 0 0 '" '" . E . , , , , ~ " " >' . ~ ~ ~ ~ " " ~ 0 . . i u u . . . " ~ -0 , , E , . . ~ -' .~ " " ~ . ~ ~ ~ " z 0 c u , , 6 6 '" .0 '" ii , , , , c . ~ . . -' g .,- w Z 0 0 0 0 " . ;i. 0; tl ~ ~ ~ ~ ,,- 0 .,- .,- -0 0 . 0 .E .,; . '5 '5 '5 '5 " 0 N . .. " " E . 0 j; .. '" '" '" ~ " . 0 0 !i a. u " ~ ~ ~ * . ~ 0 . . , 0 . 0 -0 0 ." " .. ~ ~ m " " " u 0 ;z u :r :r ;z " " " " 0 0. 0. '" >- '" "! - ~ <> '5 ... ri . .. Ii' .. 0. ;;; ,.; ;1;. ~ ~ .. 00 '" ;t 00. ~ "' .. 00 '" ;t "!. :;; .. >- >-z ww z" -'''' "'" >-w 0'" >-'" .. '" w ~...J!Z m~~ "w'" "'>-'" ~~m - '" ::: " '" w u >- >...Jz ffi~~ "'w'" ",>-'" ~:im " '" ;0 .. '" >->- zz uWw ::i~~ m>", ~fi!m !~ ,.>- UZ ZW w" -'" u", -w tti~ 0" ,,>- zffi >" "'" 0.'" >-w w'" zlll ~!Z 3'w z" OW -> !;tfi! "0. -'" ;l- -'''' ww um "''' "" o.z z 0 " 0. 0: u '" w 0 >- 0 -' w " " z '" w z ~ 1:: '" W 0. Ii! 0. Engineering Department City Hall 50 West 13th Street Dubuque, Iowa, 52001.4864 (563)-589-4270 office (563)-589-4205 fax D~~~E ~<k~ November 27, 2006 Nowata Street Reconstruction Project Notice of Final Schedule of Assessment General Information Dear Property Owner: The Final Schedule of Assessments for the Nowata Street Reconstruction Project was approved and adopted by the City Council on November 20, 2006. Enclosed please find the final assessment for your property for said improvements which are in accordance with the provisions of Section 384.63 of the Code of lowa_ The City provides an opportunity for owners of owner-occupied residential property to apply for the City's low- and moderate-income special assessment assistance program. Based on family size and income level, a property owner can receive a 20% to 100% reduction on the street improvement, water service, and sanitary lateral portions of the total assessment. Enclosed is additional information relating to the application and filing for financial assistance. If you wish to apply for financial assistance, your application must be received by the City Engineering Department no later than December 22. 2006. The final assessment may be paid in full or in part without interest at the City of Dubuque, Office of the City Treasurer, City Hall, 50 W. 13th Street, Dubuque, Iowa 52001, within 30 days from date of this letter. After 30 days, any unpaid assessment will be levied against said benefited property with the Dubuque County Treasurer and will be payable in 10 annual installments at the County Treasurer's Office, Dubuque County Courthouse, 720 Central, Dubuque, Iowa, and will draw annual interest at nine percent (9%). Should you have any questions or need additional information, please contact Kelly Ambrosy at 563.589.4270. Sincerely, ~J Sck1 Robert D. Schiesl, P.E. Assistant City Engineer City of Dubuque Enclosure November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Baal, Nicholas A. 1200 Nowata Dubuque, IA 52001 1200 Nowata Property Assessed: Parcel #: Legal Description: 10-26-207-007 Lot 9 Pinehurst Sub. Property Valuation w/lmprovement: $80,300.00 Public Improvements Paving Assessment: Net Public Improvements: $1,369.59 $ .00 $ .00 $ .00 $ .00 (-) $1,369.59 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: Net Private Improvements: $ .00 $ 964.86 $ 964.86 Sanitary Service Lateral: November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: DeMuth, Mark R. & Kathryn L. 1350 Nowata Dubuque, IA 52001 1350 Nowata Property Assessed: Parcel #: Legal Description: 10-26-207-001 Lot 15 Pinehurst Sub. Property Valuation wl/mprovement: $75,500.00 Public Improvements Paving Assessment: Net Public Improvements: $1,369.59 $ .00 $ .00 $ .00 $ .00 (-) $1,369.59 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: Net Private Improvements: $ .00 $1,110.82 $1,110.82 Sanitary Service Lateral: November 27,2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Kluesner, Nathan R. & Sharon K. 1020 Nowata Dubuque, IA 52001 1020 Nowata Property Assessed: Parcel #: Legal Description: 10-26-207-011 Lot 5 Pinehurst Sub. Property Valuation w/lmprovement: $151,000.00 Public Improvements Paving Assessment: Net Public Improvements: $1,621.60 $ .00 $ .00 $ .00 $ .00 (-) $1,621.60 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: Net Private Improvements: $ .00 $1,081.63 $1,081.63 Sanitary Service Lateral: November 27,2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Connolly, Darlene 1495 University Dubuque, IA 52001 Property Assessed: 1495 University Parcel #: Legal Description: 10-26-207-023 Lot 2 Pinehurst Sub. Property Valuation w/lmprovement: $81,000.00 Public Improvements Paving Assessment: Net Public Improvements: $2,592.64 $ .00 $ .00 $ .00 $ .00 (-) $2,592.64 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: Net Private Improvements: $ .00 $1,256.79 $1,256.79 Sanitary Service Lateral: November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Heinz, Steven A. & Pamela J. 1150 Nowata Dubuque, IA 52001 Property Assessed: 1150 Nowata Parcel #: Legal Description: 10-26-207-008 Lot 8 Pinehurst Sub. Property Valuation w/lmprovement: $79,100.00 Public Improvements Paving Assessment: Net Public Improvements: $1,369.59 $ .00 $ .00 $ .00 $ .00 (-) $1,369.59 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: Net Private Improvements: $ .00 $ 877.28 $ 877.28 Sanitary Service Lateral: November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Hoelscher, Larry G. & Jennifer Y. 1330 Nowata Dubuque, IA 52001 Property Assessed: 1330 Nowata Parcel #: Legal Description: 10-26-207-002 Lot 14 Pinehurst Sub. Property Valuation w/lmprovement: $83,900.00 Public Improvements Paving Assessment: Net Public Improvements: $1,369.59 $ .00 $ .00 $ .00 $ .00 (-) $1,369.59 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: Net Private Improvements: $ .00 $1,140.02 $1,140.02 Sanitary Service Lateral: November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: King, David M. & Mary J. 1290 Nowata Dubuque, IA 52001 Property Assessed: 1290 Nowata Parcel #: Legal Description: 10-26-207-003 Lot 13 Pinehurst Sub. Property Valuation w/lmprovement: $105,000.00 Public Improvements Paving Assessment: Net Public Improvements: $1,369.59 $ .00 $ .00 $ .00 $ .00 (-) $1,369.59 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: Net Private Improvements: $ .00 $ 994.05 $ 994.05 Sanitary Service Lateral: November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Moldenhauer, Kerin Kae 1250 Nowata Dubuque, IA 52001 Property Assessed: Vacant Parcel #: Legal Description: 10-26-207-005 NW 1/2 Lot 11 Pinehurst Sub. Property Valuation w/lmprovement: $6,600.00 Public ImDrovements Paving Assessment: Net Public Improvements: $ 684.80 $ .00 $ .00 $ .00 $ .00 (-) $ 684.80 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private ImDrovements Water Service Lateral: $ .00 Sanitary Service Lateral: Net Private Improvements: $ .00 Property Owner: Mailing Address: Property Assessed: Parcel #: Legal Description: Property Valuation w/lmprovement: Public Improvements Paving Assessment: Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: November 27, 2006 Nowata Street Paving Project FINAL Assessment Moldenhauer, Kerin Kae 1250 Nowata Dubuque, IA 52001 1250 Nowata 10-26-207-004 Lot 12 Pinehurst Sub. $126,200.00 Net Public Improvements: Private Improvements Water Service Lateral: Sanitary Service Lateral: Net Private Improvements: $1,369.59 $ .00 $ .00 $ .00 $ .00 (-) $1,369.59 $ .00 $1,110.82 $1,110.82 November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Mulgrew Oil Company Box 894 Dubuque, IA 52004-0894 Property Assessed: 1450 Loras Parcel #: Legal Description: 10-23-466-001 Lot 16 Pinehurst Sub. Property Valuation w/lmprovement: $100,800.00 Public Improvements Paving Assessment: Net Public Improvements: $ 940.07 $ .00 $ .00 $ .00 $ .00 (-) $ 940.07 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: $ .00 Sanitary Service Lateral: Net Private Improvements: $ .00 Property Owner: Mailing Address: Property Assessed: Parcel #: Legal Description: Property Valuation wllmprovement: Public Improvements Paving Assessment: Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: November 27,2006 Nowata Street Paving Project FINAL Assessment Mulgrew Oil Company Box 894 Dubuque, IA 52004-0894 1450 Loras 10-23-466-001 Lot 17 Pinehurst Sub. wlLot 16-Pinehurst Sub. Net Public Improvements: Private Improvements Water Service Lateral: Sanitary Service Lateral: Net Private Improvements: $2,478.38 $ .00 $ .00 $ .00 $ .00 (-) $2,478.38 $ .00 $ .00 November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Oswald, Louis J. & Rose E. 1080 Nowata Dubuque, IA 52001 Property Assessed: 1080 Nowata Parcel #: Legal Description: 10-26-207-010 Lot 6 Pinehurst Sub. Property Valuation w/lmprovement: $130,300.00 Public Improvements Paving Assessment: Net Public Improvements: $1,571.47 $ .00 $ .00 $ .00 $ .00 (-) $1,571.47 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: Net Private Improvements: $ .00 $1,169.21 $1,169.21 Sanitary Service Lateral: November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Peterson, Gary D. & Lili M. 1220 Nowata Dubuque, IA 52001 Property Assessed: 1220 Nowata Parcel #: Legal Description: 10-26-207-006 Lot 10 Pinehurst Sub. Property Valuation w/lmprovement: $103,300.00 Public Improvements Paving Assessment: Net Public Improvements: $1,369.59 $ .00 $ .00 $ .00 $ .00 (-) $1,369.59 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: $ .00 Sanitary Service Lateral: $ 935.66 Net Private Improvements: $ 935.66 November 27,2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Peterson, Gary D. & Lili M. 1220 Nowata Dubuque, IA 52001 1220 Nowata Property Assessed: Parcel #: Legal Description: 10-26-207-006 SE 1/2 Lot 11 Pinehurst Sub. Property Valuation wllmprovement: wlLot 10-Pinehurst Sub. Public Improvements Paving Assessment: Net Public Improvements: $ 684.80 $ .00 $ .00 $ .00 $ .00 (-) $ 684.80 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: $ .00 Sanitary Service Lateral: Net Private Improvements: $ .00 November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Scremin, Kathleen Ann 1475 University Dubuque, IA 52001 Property Assessed: 1475 University Parcel #: Legal Description: 10-26-207-025 Lot 4 Pinehurst Sub. Property Valuation w/lmprovement: $95,500.00 Public Improvements Paving Assessment: Net Public Improvements: $ 223.24 $ .00 $ .00 $ .00 $ .00 (-) $ 223.24 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: $ .00 Sanitary Service Lateral: Net Private Improvements: $ .00 November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Thoms, Erik T. & Christine R. 1120 Nowata Dubuque, IA 52001 Property Assessed: 1120 Nowata Parcel #: Legal Description: 10-26-207-009 Lot 7 Pinehurst Sub. Property Valuation w/lmprovement: $102,600.00 Public Improvements Paving Assessment: Net Public Improvements: $1,369.59 $ .00 $ .00 $ .00 $ .00 (-) $1,369.59 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: Net Private Improvements: $ .00 $ 906.47 $ 906.47 Sanitary Service Lateral: November 27,2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: Willman, Raymond F. & Phyllis A. 1485 University Dubuque, IA 52001 Property Assessed: 1485 University Parcel #: Legal Description: 10-26-207-024 Lot 3 Pinehurst Sub. Property Valuation w/lmprovement: $92,900.00 Public Improvements Paving Assessment: Net Public Improvements: $ 920.37 $ .00 $ .00 $ .00 $ .00 (-) $ 920.37 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: $ .00 Sanitary Service Lateral: Net Private Improvements: $ .00 November 27,2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: City of Dubuque 50 W. 13th Street Dubuque, IA 52001 Property Assessed: Allison Henderson Parcel #: Legal Description: 10-26-206-002 Lot 1 Pinehurst Sub. Property Valuation w/lmprovement: Exempt Public Improvements Paving Assessment: Net Public Improvements: $24,113.42 $ .00 $ .00 $ .00 $ .00 (-) $24,113.42 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: $ .00 Sanitary Service Lateral: Net Private Improvements: $ .00 November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: City of Dubuque 50 W. 13th Street Dubuque, IA 52001 Property Assessed: Allison Henderson Parcel #: Legal Description: 10-26-206-002 Lot 18 Pinehurst Sub. Property Valuation w/lmprovement: Exempt Public Improvements Paving Assessment: Net Public Improvements: $3,155.23 $ .00 $ .00 $ .00 $ .00 (-) $3,155.23 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: $ .00 Sanitary Service Lateral: Net Private Improvements: $ .00 November 27,2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: City of Dubuque 50 W. 13th Street Dubuque, IA 52001 Property Assessed: Allison Henderson Parcel #: Legal Description: 10-26-206-002 Lot 19 Pinehurst Sub. Property Valuation w/lmprovement: Exempt Public Improvements Paving Assessment: Net Public Improvements: $1,217.65 $ .00 $ .00 $ .00 $ .00 (-) $1,217.65 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: $ .00 Sanitary Service Lateral: Net Private Improvements: $ .00 November 27, 2006 Nowata Street Paving Project FINAL Assessment Property Owner: Mailing Address: City of Dubuque 50 W. 13th Street Dubuque, IA 52001 Property Assessed: Allison Henderson Parcel #: Legal Description: 10-26-206-002 Lot 20 Pinehurst Sub. Property Valuation w/lmprovement: Exempt Public Improvements Paving Assessment: Net Public Improvements: $ 693.95 $ .00 $ .00 $ .00 $ .00 (-) $ 693.95 Sidewalk Assessment: Sanitary Sewer Assessment: Watermain Assessment: Deficiency: Private Improvements Water Service Lateral: $ .00 Sanitary Service Lateral: Net Private Improvements: $ .00 Engineering Department City Hall 50 West 13th Street Dubuque, Iowa, 52001-4864 (563)-589-4270 office (563)-589-4205 fax D~~~E ~c!4-~ November 27,2006 Nowata Street Reconstruction Project Notice of Final Schedule of Assessment General Information Dear Property Owner: The Final Schedule of Assessments for the Nowata Street Reconstruction Project was approved and adopted by the City Council on November 20, 2006. Enclosed please find the final assessment for your property for said improvements which are in accordance with the provisions of Section 384.63 of the Code of Iowa. The City provides an opportunity for owners of owner-occupied residential property to apply for the City's low- and moderate-income special assessment assistance program. Based on family size and income level, a property owner can receive a 20% to 100% reduction on the street improvement, water service, and sanitary lateral portions of the total assessment. Enclosed is additional information relating to the application and filing for financial assistance. If you wish to apply for financial assistance, your application must be received by the City Engineering Department no later than December 27,2006. The final assessment may be paid in full or in part without interest at the City of Dubuque, Office of the City Treasurer, City Hall, 50 W. 13th Street, Dubuque, Iowa 52001, within 30 days from date of this letter. ,o,~~,.Aft8f~~O days, afly--unpaidassessment will-be levied against satd'lJerrefitedpropertY-Wlftr the Dubuque County Treasurer and will be payable in 10 annual installments at the County Treasurer's Office, Dubuque County Courthouse, 720 Central, Dubuque, Iowa, and will draw annual interest at nine percent (9%). Should you have any questions or need additional information, please contact Kelly Ambrosy at 563.589.4270. Sincerely, ~ SckJ Robert D. Schiesl, P.E. Assistant City Engineer City of Dubuque Enclosure NOWATA STREET RECONSTRUCTION PROJECT INFORMATION FOR ELIGIBLE PROPERTY FOR LOW AND MODERATE INCOME FAMILIES Enclosed are application forms for financial assistance, which is available from the City of Dubuque to defray a portion of or all of special assessments for the NOWATA STREET RECONSTRUCTION PROJECT for qualifying property owners. Applications must be received by 5:00 on December 27,2006. The City is funding this financial assistance with 1% Local Option Sales Tax Funds. The financial assistance is available for owner-occupied residential properties with low and moderate-income families. Qualifying families are eligible to receive between 20% and 100% of the amount of a special assessment (depending upon income level). Persons In Household 1 2 3 4 5 6 7 8 or more Financial Assistance Available Maximum Gross Income Maximum Gross Income for 20% Fundina for 100% Fundina $32,850 $16,425 $37,550 $18,775 $42,250 $21,125 $46,950 $23,475 $50,700 $25,350 $54,450 $27,225 $58,200 $29,100 $61,950 $30,975 Gross income shall include: 1. Interest, wages, and other taxable earnings documented by the latest Federal Income Tax return and supporting W-2's. 2. Workers' compensation payments. 3. Child support received. 4. Annual social security benefits (unless subject to tax and reported on tax returns) as documented on Form SSA-1099. 5. Earned Income Tax Credit 6. Pension Income If you are not required to file a Federal Tax form, verification of income must be submitted. Gross income must be reported on a household basis. Enclosed are the following documents, which can be utilized to complete an application for financial assistance. 1. Application for financial assistance. 2. Social Security verification forms. 3. Proposed special assessment amount. Contact the City Engineering Division at (563) 589-4270 to obtain further information relating to this financial assistance program. Name: Address: City, St., Zip Date: # In Household: Under 18 Over 65 Residence Descriotion: Single Family _ Bet. 18 & 65 Total in Household Rental_ (# of units ----> Income Verification Needed with Submittal of Application: IF INCOME TAX WAS FILED FOR PREVIOUS YEAR - attach copy of last year Federal Income Tax return (as submitted to IRS) including copies ofW-2's. IF NO INCOME TAX FILED ~ state source of income and attach verification of income such as Social Security, Pension, Child Support, etc. I/We authorize the City of Dubuque to contact my source of income, including employer, in order to verify amounts for purpose of qualification for the Financial Assistance Program. I/We also certify that this residence is occupied by legal owner of record. I/We certify that the above information given to the City of Dubuque, Engineering Department, is accurate and complete to the best of my/our knowledge. I/We also understand that false statements of information are grounds for denial of assistance. Signature of Owner Home Phone # Work Phone # Signature of Owner Home Phone # Work Phone # Please complete fully and information) to the followinl!: accurately and submit application City of Dubuque, Engineering 50 W. l3ID Street Dubuque, IA 52001-4864 {includinl! any back-up If you have any questions on the Financial Assistance Program, please contact the City of Dubuque, Engineering Department - (563) 589-4270. *************************************************************************************************** For Office Use Only: Received by City on Date Approved Date Denied