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Claim by Lorraine KelleherfV~ ./ CLAIM AGAINST THE CITY OF DUBUQUE, IOWA Q,~ }. ~ ~~) f 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 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. Name of Claimant: c.,~~-,,~1 ~, lt'~--~'-~~ ~~ 2. Address: ~~~ ~ ~ %~~~~ ~~~~ .~ 3. Telephone Number 4. Date of Incident: ~//~ ~ .-f~i ~ , ~ ~ ~' 5. Time of incident: GrL~~~~~..~ ~D - ~~ ~`~ 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 .. --- 9. Give name, and address of and witnesses: 10. Did police investigate? (If so, give names of officers.) ~~ ~ 8. What were weather conditions like? -~~ 6 G~ ~ ~~~~~ 11.~s 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~.)~~O ~1,~ ~ ~ ~ /" s ~~~~[~ Q~ `~-Lrc-y~C.~6-?r ~iC.b-~-YJ M s/ / ~_//i~,r ~_, , ~~i1 Tl6 .l /eQ „G(~`~~, S ~y,L~./~s.~ 9 `~.-~i~~9 ~ > 1dD ~_iJ ~/~~s ~Ow -~ ~ /l~~i~ 0.0 ~ ~~C_Y~ 13. What other damages do you claim, if any? ~~~ ~~.2ac. D ktoo _ ~ - 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.) d . 30 X60 _ ~./ .u,Q9o9 -~~6 0 15. Wha~t/amount do you/ claim from the //City of Dubuque? 16. Why do you claim the City of Dubuque is responsible? ~-~~~c.o ~~~ ~-.i~ ~!J ~,~-~ .~ZJ o.ti ~ ~~~ 1f~1 Z~ o . .. 17. Have you made any claim against anyone else for damages as a result of this incide~~ (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 this ~ `7 day of ~~i~2..f/ , 20_Z. ~ ° \\ ~~ ..-. (Signature) ~ ~ s ~ ~ .~ ,t a~ ~ ~ ~~ ~" t~E.L ~ ~= ti' ~K . ~= "' ~ D ~ o ~l (Print Name) ~. ~ v CARPET ONE` CARPET SHACK ~ ~. ~ 587 University Ave • Dubuque, IA 52001 Phone(563) 557-7212 • FAX (563) 584-2086 www.carpetone.com I E_STIM_ATE FOR Kelleher Lorraine 400 O'Neill Dubuque, IA 52001 ~ 582-2067 Estimate ESTIMATE NO. DATE 5241841 03/21 /07 AREA DESCRIPTION QUANTITY PRICE TOTAL Downstairs 6027,CORONADO 12 732 33' 2" 398.00 Sft 1.99 792.02 1/2" SUPER MAGIC 6 I.. 6 LB 66' 0" 396.00 Sft 0.65 257.40 INS CPT: N-BERB CON.. - 396' 0" Square Feet 0.57 225.72 INS CPT: STAIR-MIN - 6.00 Each 6.00 36.00 ~ MTL: GOLD PIN STD. - 20.16 Linear Feet 1.14 22.98 I " INS CPT: T/O -CPT & P.. tearout stairs cpt &.. 1.00 Feet Of Labor 15.00 I 15.00 INS CPT: METAL-CONC.. - 20.16 Each 2.00 ; 40.32, En.. ~ j Laundry BENCHMARK # 3711 ? 10' 0" 120.00 Sft ~ 1.78 213.60 , ~ INS VIN: SPECIAL QUO.. pattern scribe laun.. 1.00 Each 200.00 200.00 j INS: MOVE APPLIANCES - 2.00 Each 30.00 60.00' " INS: PULURESET TOI.. - 1.00 Each 85.00 85.00 " i ~ i I l INS VIN: SPECIAL QUO.. Floor Prep in Vinyl .. 1.00 Each 45.00 45.00 i I This estimate is good for I S days. If it meets with your approval, please sign and return with a SO% deposit of the total estimate ay SUB TOTAL 1993.04 tount. TAX 78.98 i TOTAL 2U72.02 i SIGNATURE ' ~~i-fit ROOFING COMPANY 2820 Elm Street Dubuque, IA 52001 phone (563) 588-2060 -Fax (563) 588-2068 B I LORRAINE KELLEHER L 400 O'NEILL L DUBUQUE IA 52001 T O 03121/07 1063 KELLLO NET 30 ~~T~~~ 1063 PAGE 1 J 1659 0 LORRAINE KELLEHER-WATER HTR B N O LORRAINE UNIT EXTENDED QUANTITY D E S C R I P T I O N PRICE PRICE REPLACE WATER HEATER WATER HEATER MODEL # 22V40F1 SER # RHLN0207423822 TOTAL QUOTED AMOUNT DUE 875.29 GROSS RETAINAGE TAX NET AMOUNT 875.29 .00 .00 875.29 AN INTEREST CHARGE OF 1 1/2% PER MONTH (18% APR) WILL BE CHARGED ON ALL INVOICES OVER 30 DAYS OLD. 8Y DATE sED SPECIAL nvssR<,criot~s ~z~t1~ a~ /~~Surict uc SERVICE ORS3ER FAST SERVICE AND PART'S FOR ANY APPLIANCE I~QB'$ ~.PPL.I~II~CP ~L1~~TIC~ a~suQUE, ~aw~ ~-r~ l ~ a-I tv~ /~ ~ ~?I~-t,Wsu-c ~ --- w~NSF II ctix ~ ^ t~vC VISA "°D~ U~ Q ~ ~~ ~~ c ClEiRCiF~ q~. ACC7 4~-(~j-G~? /`'I $- ~ -- ~-- PH t~s31 ss~•or~~ l > 1 pr+o~ ~~.. r~-n ~ ~3~i~'J - ~ ~~ ~~ ~~ ~o~o~ F t /sa' Dubuque Area Steamatic, Inc. /~~ ST~:~4MATIC, \\~/1/ BILL TO Lorraine Kelleher 400 OTieill St. Dubuque, IA. 52001 500 Huff St. P.O. Box 1164 Dubuque, IA 52004-1164 563-556-5821 P.O. NO. TERMS Net 10 Days ITEM DESCRIPTION 30185-WATER R Drying and clean up of basement due to water main break DATE 3/22/2007 DUE DATE TECH 3/31/2007 SERVICE DATE 3/8/2007 We appreciate your business. Thank you. Total Invoice INVOICE # 14895 REP CL A 3,118.97 $3,118.97 Dubuque Area 5teamatic .anS 8 ~N.ru«.n ~~ 500 Huff Street Dubuque, Iowa 52003 (563)556-5821 Client: Kelleher, Lorraine Property: 400 ONiel Dubuque, IA 52001 Operator Info: Operator: CHAD Estimator: Chad Lukes Business: 500 Huff Street Reference: Company: Business: Type of Estimate: Dates: Date Entered: Dubuque, IA 52003 Dubuque Area 5teamatic 500 Huff Steet Dubuque, IA 52003 Sewage 03/14/2007 Price List: IADU4B7A Restoration/Service/Remodel Estimate: 2007-03-14-1526 Home: (563) 582-2067 Business: (563) 556-5821 Business: (563) 556-5821 ST Dubuque Area Steamatic bfd Ann~vsd n+hrginn ~~ 500 Huff Street Dubuque, Iowa 52003 (563)556-5821 2007-03-14-1526 Area Items: 2007-03-14-1526 Emergency service call -during business hours 1.00 EA Equipment setup, take down, and monitoring (hourly charge) 2.00 HR Add for personal protective equipment (hazardous cleanup) 6.00 EA Dehumidifier (per 24 hour period) - XLarge - No monitoring 8.00 EA Haul debris -per pickup truck load -including dump fees 1.00 EA Content Manipulation charge -per hour 4.00 HR Moving charge -per hour 2.00 HR Clean sofa -Heavy clean 7.00 LF Clean and deodorize ottoman -plain fabric -Heavy clean 1.00 LF Clean chair 3.00 EA Equipment decontamination charge -per piece of equipment 1.00 EA Main Level Room: family Ceiling Height: 8' Water extraction from floor -Category 3 water 200.34 SF Tear out wet non-salvageable carpet, cut/bag -Cat 3 water 176.34 SF Tear out tackles strip and bag for disposal 54.08 LF Tear out wet carpet pad, cut/bag -Category 3 water 176.34 SF Tear out non-salvageable vinyl, cut & bag for disposal 24.00 SF Baseboard -Detach 54.08 LF Clean floor -Heavy 400.68 SF Apply anti-microbial agent 400.68 SF Remove Carpet -metal transition strip 10.00 LF Tear out wet drywall, cleanup, bag for disposal 54.08 SF Tear out and bag wet insulation 54.08 SF Clean door (per side) 2.00 EA Room: heater Ceiling Height: 8' Water extraction from floor -Category 3 water 12.50 SF Clean floor -Heavy 25.00 SF Apply anti-microbial agent 25.00 SF Room: bath Ceiling Height: 8' Subroom 1: closet Ceiling Height: 8' Water extraction from floor -Category 3 water 52.26 SF Tear out non-salvageable vinyl, cut & bag for disposal 52.26 SF Baseboard -Detach 40.98 LF 2007-03-14-1526 03/22/2007 Page: 2 ST Dubuque Area Steamatic beJ tk,:us x nw.alba ~/.~ 500 Huff Street Dubuque, Iowa 52003 (563)556-5821 CONTINUED -bath Clean floor -Heavy Apply anti-microbial agent Clean toilet 104.51 104.51 1.00 SF SF EA Room: hall Ceiling Height: 8' Subroom 1: closet Ceiling Heigh t: 8' Water extraction from floor -Category 3 water 99.76 SF Tear out wet non-salvageable carpet, cut/bag -Cat 3 water 80.99 SF Tear out wet carpet pad, cut/bag -Category 3 water 80.99 SF Baseboard -Detach 57.96 LF Clean floor -Heavy 199.53 SF Apply anti-microbial agent 199.53 SF Remove Carpet -metal transition strip 3.00 LF Tear out wet drywall, cleanup, bag for disposal 57.96 SF Tear out and bag wet insulation 57.96 SF Tear out tackles strip and bag for disposal 57.96 LF Interior door -Detach & reset -slab only 2.00 EA Clean door (per side) 4.00 EA Room: wtrheater Ceiling Height: 8' Water extraction ftom floor -Category 3 water 5.06 SF Clean floor -Heavy 10.11 SF Apply anti-microbial agent 10.11 SF Room: steps Ceiling Height: 17' Remove Carpet 54.49 SF Remove Carpet pad 54.49 SF Grand Total 3,118.97 2007-03-14-1526 03/22/2007 Page: 3 ST Dubuque Area Steamatic Mdsk~ewed r{+NrNn~ ~/~/ 500 Huff Street Dubuque, Iowa 52003 (563)556-5821 Grand Total Areas: 1,648.22 SF Walls 430.30 SF Floor 0.00 SF Long Wall 430.30 Floor Area 833.91 Exterior Wall Area 0.00 Surface Area 0.00 Total Ridge Length Chad Lukes 393.44 SF Ceiling 47.81 SY Flooring 0.00 SF Short Wall 443.32 Total Area 93.83 Exterior Perimeter of Walls 0.00 Number of Squares 0.00 Total Hip Length 2,041.66 SF Walls and Ceiling 208.55 LF Floor Perimeter 197.05 LF Ceil. Perimeter 1,726.80 Interior Wall Area 0.00 Total Perimeter Length 2007-03-14-1526 03/22/2007 Page: 4 ~. Dubuque Area Steamatic, Inc. ~~ STEAMATIC ~~/~ BILL TO Lorraine Kelleher 400 O`Neill St. Dubuque, lA. 52001 500 Huff St. P.O. Box 1164 Dubuque, IA 52004-1 1 64 563-556-5821 P.O. NO. TERMS Net 10 Days ITEM DESCRIPTION 30285-SUBWATE Repairs in basement due to water main break DATE 3/27/2007 DUE DATE TECH 3/31/2007 SERVICE DATE We appreciate your business. Thank you. Tota I Invoice INVOICE # 3006 REP CL ..,. 4,285.75 $4,285.75 R ST Dubuque Area Steamatic iaeJ ~ka.~.c d n+F. a1in. ~/~ 500 Huff Street Dubuque, Iowa 52003 (563)556-5821 Client: Kelleher, Lorraine Property: 400 ONeill Dubuque, IA 52001 Operator Info: Operator: CHAD Estimator: Chad Lukes Business: 500 Huff Street Reference: Company: Business: Type of Estimate: Dates: Date Entered: Dubuque, IA 52003 Dubuque Area Steamatic 500 Huff Steet Dubuque, IA 52003 Sewage 03/ 14/2007 Price List: IADU4B7A Restoration/Service/Remodel Estimate: 2007REPARWOFLRING Home: (563) 582-2067 Business: (563) 556-5821 Business: (563) 556-5821 ~' . 4 ST Dubuque Area Steamatic ~/~ 500 Huff Street Dubuque, Iowa 52003 (563)556-5821 2007REPARWOFLRING Area Items: 2007REPARWOFLRING Clean and deodorize carpet 1.00 EA cost to clean hallway on main floor where there was foot traffic. Main Level Room: family Ceiling Height: 8' Acoustic plaster over 1/2" gypsum core blueboard 108.17 SF Batt insulation - 6" - R19 54.08 SF SeaUprime the walls and ceiling -one coat 633.01 SF Paint the walls and ceiling -one coat 633.01 SF Baseboard - 2 1/4" stain grade 54.08 LF Stain & finish baseboard 54.08 LF R&R Casing - 2 1/4" stain grade 38.00 LF Stain & finish casing 38.00 LF Room: bath Ceiling Height: 8' Subroom 1: closet Ceiling Height• 8' Subroom 2: shower Ceiling Height• 8' Baseboard - 2 1/4" stain grade 50.82 LF Stain & finish baseboard 50.82 LF R&R Casing - 2 1/4" stain grade 55.00 LF Stain & finish casing 55.00 LF Room: hall Ceiling Height: 8' Subroom 1: closet Ceiling Height• 8' Acoustic plaster over 1/2" gypsum core blueboard 115.91 SF Batt insulation - 6" - R19 57.96 SF Seal/prime the walls and ceiling -one coat 563.41 SF Paint the walls and ceiling -one coat 563.41 SF Baseboard - 2 1/4" stain grade 57.96 LF Stain & finish baseboard 57.96 LF R&R Casing - 2 1/4" stain grade 50.00 LF Stain & finish casing 50.00 LF Room: steps Ceiling Height: 17' 2007REPARWOFLRING 03/26/2007 Page: 2 r ' /' ST Dubuque Area Steamatic wr.+ca.~.ss mw~.w~ 500 Huff Street Dubuque, Iowa 52003 (563)556-5821 CONTINUED -steps Paint the walls and ceiling -one coat 161.46 SF Seal/prime the walls and ceiling -one coat 161.46 SF Room: Heat, Vent, & Cool Furnace -service call to check 1.00 EA Dryer -Remove & reset -gas 2.00 EA removing and resetting twice so she can do laundry while flooring is being ordered. Grand Total 4,285.75 Chad Lukes Grand Total Areas: 1,648.22 SF Walls 393.44 SF Ceiling 2,041.66 SF Walls and Ceiling 430.30 SF Floor 47.81 SY Flooring 208.55 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 197.05 LF Ceil. Perimeter 430.30 Floor Area 443.32 Total Area 1,726.80 Interior Wall Area 833.91 Exterior Wall Area 93.83 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squazes 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length 2007REPARWOFLRING 03/26/2007 Page: 3 cea Steamahc Dubuque A gT~ a<~~=^~"""" 500 Huff Street 3 ~ubuAUe~5821 5200 (563)556- amain Level r ~, ~:.. , Main level 03I261200~ Page: 4 _..~~uFYARw~FLR~G .7V[s. Lorraine .7~elleFier ,~: ~ ~~ ~aiP_t,df~.~ - ~~ - ~o~a, oa ~7s a 9 ~e-~, ~~s.r~s~« - 9,00 ~~