Claim - Viertel, Merle A.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: Merle A. Viertel
2. Address: 2880 Northridge Dr.
3. Telephone Number: 582 8377
4. Date of Incident: 1st time 1980 2nd time 1995
5. Time of Incident: Unknown
6. Location of Incident (Be specific): Sanitary Sewer broke - underneath curb 20' out from house & 10' in from manhole
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.)
In 1980 water main broke and undermined curb and gutter, curb and gutter had to be replaced from corner to lower driveway (150'). I had trouble
from that time on. In 1995 curb and gutter sunk again and had to be replaced.
8. What were weather conditions like? Unknown
9. Give name and address of any witnesses: Tom Buelow, 2881 Northridge Dr.
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 company and amount paid.)
15. What amount do you claim from the City of Dubuque? $871.24 Fondell Excavating
$141.04 Schwartd Plbg & Htg.
16. Why do you claim the City of Dubuque is responsible?
Because Curb and Gutter sunk and broke Sanitary Sewer
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 17th day of December, 2001. , 20 .
/s/ Merle A. Viertel
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
C L AIM AGAINST THE CITY OF DUBUQUE, IO WA --~-~~~
This written report constitutes your claim against the City of Dubuque, Iowa, You ~hould
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- /~, ~///E~,~ 7-/~/_
2. Address:
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific): ~,.:~. ~.~.,.~
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
emplp, yee'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 injt~ies).
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.)
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
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 i ?~ day of
, 20~/ .
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
Fondell Excavating
2270 Crown Point Road
Dubuque IA 52002
Invoice
DATE INVOICE #
12/7/2001 668
BILL TO
Merle Viertel
2880 Northridge
Dubuque, IA 52001
P.O. NO. TERMS PROJECT
N10 '
SERVICED DESCRIPTION QUANTITY RATE AMOUNT
10/8/2001 871.24 871.24
Machine Time, Labor, Tracking, Concrete &
Basestone
Sewer Break
0/
Thank You
Total
$871.24
TERMS NET 10 DAYS FROM INVOICE DATE. A LATE CHARGE OF 1 1/2% PER MONTH WILL
BE ADDED ON PAST DUE ACCOUNTS. THIS IS AN ANNUAL PERCENTAGE RATE OF 18%.
Schwartz Plumbing & Heating Inc.
4904 Asbury Road
Dubuque, IA 52002
(319) 557-t145
Invoice
DATE INVOICE #
10/8/2001 11994
BILL TO
I Soup Viertel Sr.
2880 Northridg¢
Dubuque, IA 52001
P.O. NO. TERMS PROJECT
Due on receipt
QUANTITY DESCRIPTION RATE AMOUNT
2
4
1.5
4" CI pipe
10/8/0t Labor/Jeff
Tmck Charge
Iowa Sales Tax
6. t9
9.67
48,00
10.00
12.38'
38.68T
72.00T
IO,OOT
6.00% T98
1.5% Service charge after 30 days $2.00 Minimum
Total $141.04