Claim by Allen Gloeckneri~
BARRY A. LINDAHL, ESQ.
CITY ATTORNEY
MEMO
To: Mayor Roy D. Buol and
Members of the City Council
DATE: April 17, 2007
RE: Claim against the City of Dubuque by Allen C. Gloeckner
Claimant Date of Claim Date of Loss Nature of Claim
Allen C. Gloeckner 04/19/07 04/07/07 Property Damage
This is a claim in which the claimant alleges that the basement of his residence located
at 2940 Muscatine Street sustained water damage due a broken water main.
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
Allen C. Gloeckner
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-10401 EMAIL balesq@cityofdubuque.org
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CLAIM AGAINST THE CITY OF DUBU UE IOWA
Q
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 13t" 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:~~ ~ ~ /L'~ ~ ° L" ~ ~ ~ C ~ ~/~ "
2. Address: ~ ~'T~ ~" ___ `
3. Telephone Number ~~C ~~
4. Date of Incident: ~' ~ - ~ / - ~'
5. Time of Incident: ~'~C,-~-~-~~ ~~~ ~~'7`~~
8. Wbat~orere weather conditions like?
9. ~~name a addres f any wit, ss ~
`~~~7 ~ ~ ~ ~3 ~.3
10. Did police investigate? (If so, give names of officers.)
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
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
13.pWhat ether darr~ge~ ~o you elai
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 ar~gpnt do you claim from the City of Dubuque?
r
1~,V~.y~do yo~~m theme CCity of Dub~ue is~sponsible?
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yeg, give name and address.)
18. If the answer to Question 17 is yes, have you received any payment from that
source, and if sq,, in what amount?
Dated this J / day of
(Signature)
`(Print Name)
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~ ~ 0 Main. S treet
Dubuque, I~ X2001
April 11, 2007
Allen Gloeckner
2940 Muscatine
Dubuque IA 52001
557-3893
Invoice: Water Damage
~, 1 ~
• Remove and replace furniture and contents
• Steam clean floor
• Apply Microban disinfectant $175.00
• 2 air movers $30 each/per day/1 day $ 60.00
• 1 pump out dehumidifier $60 per day/1 day $ 60.00
Total: $295.00
563-3~6-6168
800-556-6168
FaY: 563-536-4680
Thank you for calling KANNDO Professional Services!