Claim by Julie GingrassBARRY /~-. LINDAHL, ESQ. t~
CITY ATTORNEY
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To: Mayor Roy D. Buol and c ~ Ill
Members of the City Council a,
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DATE: April 5, 2007 c
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RE: Claim against the City of Dubuque by Julie Gingrass
Claimant Date of Claim Date of Loss Nature of Claim
Julie Gingrass 04/05/07 03/07/07 Property Damage
This is a claim in which the claimant alleges that the basement of her residence located
at 595 O'Neill Street sustained water damage due to a watermain break on O'Neill
Street.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
BAL:tIs
cc: Michael C. Van Milligen, City Manager
Jeanne Schneider, City Clerk
Bob Green, Water Department Manager
Julie Gingrass
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 balesq@cityofdubuque.org
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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 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: J l ~'~ ~"`~~'~ ~
2. Address
3. Telephone Number S~3 -~~13 ' G.3 :z `~
4. Date of Incident: 3~7/ ~ m° 7
5. Time of Incident: q `3 ~ d - M
6. Loca ion of Incident (Be specifi ):
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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
the employee's name.)
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8. What were weather conditions like?
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9. Give name and address o any ~
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10. Did olice investigate? (If so, give na es of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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.)
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13. What other damages do yQu 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.)
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15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of ubuque is responsible?
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17. Have you made any claim against anyone else for damages as a result of
this i~dent? (If yes, give name and address.)
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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 ~~ day of ~~J~Q- ~ 20- °~~ ~~nbngna
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(Sign ture) 8~ :~~ Nn Sr ~~~ L~
(Print Name) (~~/`~~~„}~
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Dubuque Area Steamatic, Inc.
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STF.A~ATIC
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BILL TO
Julie Gingrass
595 O'Neill St.
Dubuque, IA. 52001
500 Huff St. ,
P.O. Box l l~f~`
Dubuque, IA 52004-1164
563-556-5821
Invoice
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DATE INVOICEY'#
3/15/2007 14899
P.O. NO. TERMS DUE DATE TECH REP
Net 10 Days 3/26/2007 CL
ITEM DESCRIPTION SERVICE DATE AMOUNT
30185-WATER R Emergency Service 3/7Rt107 125.00
30185-WATER R Labor 3/9/2007 385.00
30196 Anti-microbial application 3/98007 75.00
30184 Equipment Rental 3/128007 450.00
30190-MISC Mist -Personal Protective Equipment, Equipment Decontamination 3/128007 90.00
We appreciate your business. Thank you.
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