Claim - Hartig, Richard J.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: Richard J. Hartig
2. Address: 560 Villa
3. Telephone Number: 556 5150
4. Date of Incident: 11-06-01 Sewer Install - 11-19-01 Sewer Backup
5. Time of Incident: 6 AM - Noon
6. Location of Incident (Be specific): 560 Villa, Dubuque, IA 52003
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.)
New Sewer (E-one) Backed up covering T.V. Room and a storage room; investigation revealed Sewer Shut off was crooked and pipe into
E-one system was bent when installed by Stewart.
8. What were weather conditions like?
Fair
9. Give name and address of any witnesses:
City Engring- Bill & Todd, Danner Plumbing (Dave & Joe)
10. Did police investigate? (If so, give names of officers.)
No
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, Carpet removed and cleaned; Storage room vacated and sanitized
Sewer Val Re-excavated and repositioned; Sewer pit connecting Re-excavated and re-plumbed.
13. What other damages do you claim, if any?
None
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?
$1,061.41 (Receipts attached - 5 Hrs. Labor of Mr. & Mrs. Hartig to Clean Stench)
16. Why do you claim the City of Dubuque is responsible?
Mandatory sewer hook-up with $10,000 Assessment and $5,000 in contractor charges; The City Hired the Contractor (Stewart) and I had to pay to repair their shoddy workmanship.
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?
N/A
Dated at Dubuque, Iowa this 19th day of December, 2001.
/s/ Richard J. Hartig
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. You should
completefhis~'orm in fUll and attacfi any additional irffotmation 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 appr~opriate department for investigation.
Once that investigation is completed, a report and recommendation Will be sij'bmitted to'he
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: '--~:cw~.z~ '3'-
2. Address:
3. Telephone Number:
4. Date 'of Incident:
-5, Time of-Incident:
6. Location of Incident:(Be sPecific): ~Go ~J; ~A
7. DESCRIBE ACCIDENT OR ~OCCURRENCE THAT ~CAU~ED INJURY OR 'DAMAGE." (Give.~'
full details upon which you base your claim. If a City employee,'was involved, give~th'e :~:
employee's name.)
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. 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 cqr0pany and amount paid.)
~p, ol~o'1 ba~f.)Ch~A-~.g~'~' ·
17. Have you made any claim against anyone else for d. amages as a result of this incident?
· (If yes, .give name and .address.) ~, ·
18. if the answer to Quegtion 17 is yes, have you received any payment from that source,
and if so, in what amount? ..... . et//~ _ ~
Dated at Dubuque, Iowa this . } ¢~:~--"~ day of
(Rev. 1/00 & 7/01)
(Print Name)
'$TEA.MATIC®
Dubuque Area Steamatic, Inc.
500 Huff St.
P.O. Box 1 t64
Dubuque, IA 52004-1164
Invoice
DATE INVOICE
11/24/2001 3562
BILL TO
] Dick & Brenda Hartig
560 Villa St.
Dubuque, IA. 52003
P,O. NO. TERMS DUE DATE REP
Net 10 Days 12/4/2001 ICIW
ITEM DESCRIPTION SERVICE DATE AMOUNT
30185-WATER R
30185-WATER R
30185-WATER R
30185-WATER R
30185-WATER R
30295-DISCOUN
Extract Water and Remove Carpet Pad
2 Air Movers ~ 25.00 per unit
I Dehumidifier
Microban Disinfectant to Floor Surface
Clean Carpet Piece affected in Shop
Discounts
Sales Tax
125.00T
50.00T
55.00T
35.00T
35.00T
-75.00T
13.50
Thank you for calling Steamatic! ~
I Total $238.50;
I
BWT Land Improvement, Inc.
11223 Golf View Drive
Galena, IL 61036
Invoice
Date Invoice #
12/17/2001 1254
B~I TO
Ric-~-Har rig
560 Villa S~xeet
Dubuque, IA 52003-7572
P.O. No. Terms Project
I
item Quantity Descdp~n Rate Amount
TB25 2 Back hoe time to find sewe~ shutoff valve 65.00 130.00
Lal~or 2 Labor to find shutoff - 26.00 52.00
TB175 1.5 Time to dig to reopen and backfill to fix sewer pit 45 85.00 127.50
Labor I Labor for dig to ~l~ir sewer pit 45 26.00 26.00
Total 33s.50
DANNER PLBG. & HTG. SERVICE Date Invoice
P.O. BOX 1409 12/10/01 803068
DUBUQUE, IOWA 52004-1409
Phone: 319-556-8516 Fax:
License ~ IOWA 34278-95
Billed to:
DICK & BRENDA HARTIG
560 VILLA STREET
DUBUQUE, IA 52003
Page: 1
Job:UNCLOG DRAIN
Category:C
Mechanic:DALE/JOE
Phone:556-5150
SERVICE FOR CHECKING AND UNCLOGGING DRAIN LINE AT THE PUMP.
UPAND CHANGE FITTING THAT WAS IN E-ONE & ADD C.O. TO GRADE.
WORK ORDERED BY DICK.
HAVE DUG
PAYMENT DUE ON RECEIPT/ 10 DAYS NET; OR BY SPECIAL AGREEMENT. 2% PER
MONTH I~ATE CHARGE, $2.00 MIN. AFTER 30 DAYS, PLUS ANY COURT COSTS,
ATTORNEY'S FEES, AND COLLECTION FEES. FID# 421-33-4924
QTY
DESCRIPTION OF MATERIAL
1
1
1
1
1
t0
1
1
4" PVC TEE
4" STREET 45^ PVC ELL
4" COUPLING PVC
4" STREET C.O. W/PLUG
4" SS U.G. NH /COUPLING
FT. 4" PVC PIPE
LABOR
TAX
Total $355.61
'FLOOR SHOW COMPANIES ORDER ACKNOWLEDGMENT
1475 ~soc;at~s Drive- Dubuque, I~ 52002 - Phone: (319) 557-9952- Toll Free: (~77) FLR~SHOW SEE PAYMENT TERMS BELOW
Hartig, Richard and Brenda
560 Villa
Dubuque IA
52003
Order Number: 70038
Order Date :11/28/01
Phone Number I: 556-5150
Phone Number 2:
Hartig, Richard and Brenda
Description
L - Repair Reseam Carpet 50.00
F - Flooring Heat tape material 10.00
F - Flooring Credit per Dick G. -30.00
=ayment Terms: Total 31,80
~lotes: 11/28/01: Dick and Brenda, please give me a call if seam needs
additional attention, I'1t be happy to stop by. Thanks.
Dick Gregory.
P.S. I picked up 1/2 of the Service Call charge as
a thanks for the furniture order! Your business
is greatly appreciated!
I Signature: ISalespers°n: Gregory, Richard