Claim by Westfield_BrimeyerBARRY A. LINDAHL, E
CITY ATTORNEY
MEMO
To: Mayor Roy D. Buol and
Members of the City Council
DATE: May 16, 2007
RE: Claim against the City of Dubuque by Jeffrey & Dianne Brimeyer,
subrogated by Westfield Insurance Company
Claimant Date of Claim Date of Loss Nature of Claim
Jeffrey & Dianne 05/14/07 03/26/07 Property Damage
Brimeyer
This is a claim in which the claimant alleges that due to a City of Dubuque sewer
backing up, the basement of claimant's residence located at 2595 Knob Hill Drive
sustained water damage.
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
John Klostermann, Street & Sewer Maintenance Supervisor
Jeffrey & Dianne Brimeyer
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
.~ '~
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. ~,%c°7`~~`t~/ ~,~,unr~~
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1. Name of Claimant: ~ -~ ~ , ~rr o 6 ~ ~ / ~~'~~Yh~,~/c°/
2. Address: ~? ~~~ l~ yam,( ~+ ~,
3. Telephone Number ~~~ i- ~`~ ~ `~~ y
4. Date of Incident:
5. Time of Incident: ~ r ~ ~-c Yl~
6.q..,Location of I cident (Be s_pecific): ,/ J~
f Si,~6. av rn r>~. ~/!~ 7 ~ 7~ ~/_ rv0 6 it/~ ~//~ /~ !,~ ~ /~ co .~,~ ~~ ~
8. What were weather conditions like?
9. Give name and address of any witnesses
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 anyoP~~ jured? (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 dam~ge.~ ~ `, ~ ~ ~ ~ ~ ~~
13. What other damages do you claim, if any? ~ /'
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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
,,
16. W do you claim the C' of Du/buque is re ponsible? /
/ ~~7 ~ c° d Y ~' G~' ~/s1 7r ~ Y ~ E' Q
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17. Have you made any claim against anyone else for damages as a result of
this incident? (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 ~~ ""~ ay of It ~ 20C~' ~ ~ nbn (1
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(Signature)
OZ ~Z Nd h 1 J~dN LO
(Print Name) Q~n~~+..)~~
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15. What amount do you claim from the City of Dubuque? / ~
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t
. WESTFIELD
INSURANCE
• .~ ~;;~ A member of Westfield Groups"'
May 10, 2007
City of Dubuque
GusPsihoyas
925 Kerper
Dubuque IA 52001
Re: Insured: JEFFREY A BRIMEYER and DIANNE BRIMEYER
Claim No.: NP,-WNP-1655975-032607-A
Date of Loss: March 26, 2007
Dear City of Dubuque:
The investigation of our insured's loss of March 26, 2007, establishes that you
are legally responsible for the damages. As stated in our letter dated April
9, 2006, we are requesting reimbursement from you or your insurance company
totaling 55,739.12.
If we have not heard from you within 10 days, we will refer this matter to our
attorney for legal action against you.
Yours truly,
Grant W. Baumann
Claims Specialist
6005 Rockwell Drive N.E., Suite A
Cedar Rapids, IA 52402 13191 393-1032 or 1-800-243-0239
FAX X319) 393-4293 wvsw.westfieldgrp.com
m 116 (Rev. 8-89)
Eastern Iowa Claims
P.O.Box 5
Bellevue, IA 52031
Office: (563) 872-3477
Estimate Claim No. WNP ~ 555975
File No. Policy No. Date of Loss Report Report Date Adjuster
EI000181 WNP 1655975 03/26/2007 First 04/24/2007 Phii Paxson
Insured Address Office Home FAX
Jeffrey and Diane Brimeyer 2595 Knob Hill (563) 583-8689
Dubuque,lA 52003
Loss Address
2595 Knob Hill
Dubuque, IA 52003
r,...,,... ndd~,.« FAX
Claimant Address r~^
Building Limit: $10,000.0 0 Deductible: S500.00
Storage Area
Floor 0 SY Wail 0 SF Ceiling 0 SF Floor Perim. 0 FT Ceiling Perim. 0 FT
Room-standard Length 0.00 FT, Width 0.00 FT, Height 0.00 FT
Operation Qty Unit Description Cost RC DEP ACV
Fee 6 Hrs Contents wipe down 29.00 174.00 0.00 174.00
Charge 340 SF Extract water, heavily soaked 0.20 68.00 0.00 63.00
Steam clean 915 SF Concrete flooring 0.19 173.85 0.00 173.85
Note: Includes garage and storage area
Storage Area Totals: 415.85 0.00 415.85
Bedroom
Fioa v SY Wail 0 SF Ceiling 0 SF Floor Ferim. 0 FT Ceiling Perim. C r"T
Room-standard Length 0.00 FT, Width 0.00 FT, Height 0.00 FT
Operation Qty Unit Description Cost RC DEP ACV
Fee 2 Hrs Contents wipe down 29.00 58.00 0.00 58.00
Charge 190 SF Extract water from carpet 0.20 38.00 0.00 38.00
Remove 190 SF Remove wet carpet and pad, wet carpet 0.85 161.50 0.00 161.50
Remove 190 SF Carpet 0.16 30.40 7.60 22.80
Replace _ 212.8 SF Carpet 3.23 637.34 171.84 515.50
Remove 190 SF Carpet pad, urethane rebound 0.08 15.20 0.00 15.20
Replace 190 SF Carpet pad, urethane rebound 0.64 121.60 0.00 121.60
Bedroom Totals: 1,112.04 1 ~ 9.44 932.60
Bar
Floor 0 SY Wail 0 SF Ceiling 0 SF Floor Perim. 0 FT Ceiling Perim. 0 FT
Room-standard Length 0.00 FT, Width 0.00 FT, Height 0.00 FT
Operation Qty Unit Description Cost RC DEP ACV
Fee 1 Hrs Contents wipe down 29.00 29.00 0.00 29.00
Charge 134 SF Extract water Q2C ~6.3C ).i;~ :,6.3G
Fee 184 SF Remove laminate flcoring C.9E 178.61 G.CC 176.6a
Replaca 184 SF Laminate wood floor -1.92 905.28 9C.5~ 814.75
Reciac= ' 84 SF Laminate wccd floor underlayment 0.19 90.16 9.C~ 31.1.t
Peciace :.. _: Laminate wcce ~Icor, =no mcieing ane cua~:ar rcunC ,~ _Oc.:;u _...~~ ,. ;=
:Cjc
.:. aateu ~~ing ?owerClaim ?. 1-3CCJ'_.6-1215
Estimate Claim No. WNP 1655975
File No. Policy No. Date of Loss Report Report Date Adjuster
EI000181 WNP 1655975 03/26/2007 First 04/24/2007 Phil Paxson
Bar Totals: 1,504.68 126.23 1,378.45
Bathroom
Floor 0 SY Wall 0 SF Ceiling 0 SF Floor Perim. 0 FT Ceiling Perim. 0 FT
Room-standard Length 0.00 FT, Width 0.00 FT, Height 0.00 FT
Operation Qty Unit Description Cost RC DEP ACV
Charge 35 SF Extract water 0.20 7.00 0.00 7.00
Fee 35 SF Remove flooring 0.65 22.75 0.00 22.75
Replace 96 SF Tile floor, Vinyl 4.06 389.76 97.44 292.32
Rem & Reinstall 1 EA Toilet 110.G0 110.C0 OAC 110.00
Bathroom Totals: 529.51 97.44 432.07
General
Operation Qty Unit Description Cost RC DEP ACV
Rent 5 day Dehumidifiers 60.00 300.00 0.00 300.00
Note: 1 unit, 5 days
Rent 15 day Drying fan 27.50 412.50 0.00 42.50
Note: 5 units, 3 days
Fee 1 E,4 Treat with antimicrobial spray, Treat floor with 102.00 102.00 0.00 1 C2.00
antimicrobial spray
Fee 1 EA Debris removal 75.00 75.00 0.00 75.00
Fee 8 Hrs Contents manipulation 28.00 224.00 0.00 224.00
General Totals: 1,113.50 0.00 1,113.50
RC R DEP NR DEP ACV
Subtotal 4,675.58 403.11 0.00 4,272.47
Tax 183.02 22.51 0.00 160.51
Building Loss: 4,858.60 425.62 0.00 4,432.98
Contents Limit: 3169,500.00
Description 4ty Age Cost RC Dep ACV
Artificial Christmas tree 1 2 99.00 99.00 19.80 79.20
Christmas lights 2 2 8.99 17.98 3.60 14.38
Ornaments, misc. 1 2 50.00 50.00 10.00 40.00
Fiber-optic scarecrow 1 3 29.99 29.99 9.00 20.99
Easter baskets 5 4 9.99 49.95 19.98 29.97
Easter decorations, misc 1 2 35.00 35.00 7.00 28.00
Fuz~les ., ~.. 5.54 ,,...,, ~ ..33
Flashcards 2 2 6.59 13.18
2.64
10.54
Bulletin bcaro 3.99 3.99 •.: x.19
Books, misc 1 2 65.00 65.00 13.C0 52.00
GiGi ball tev 1 3 22.99 22.99 1C.~5 "2.5-t
-rain :.,. - =~. - , _...,._ __ -. ._ .
Busy balls set -!9.94 19.99 _...., ..99
Toss across game - 11.95 11.59 -.~~ :.19
Crzated using PowerC'S~m :~. 1-dC0--6-t73f
~~
Estimate Claim No. WNP 1655975
File No. Policy No. Date of Loss Report Report Date Adjuster
EI000181 WNP 1655975 03126!2007 First 04/24/2007 Phil Paxson
Kitchen set 1 2 24.99 24.99 7.50 17.49
Play food 1 2 19.00 19.00 5.70 13.30
Rugs, large entry 2 2 24.99 49.98 10.00 39.98
Rugs, small 2 2 16.99 33.98 6.80 27.1 d
Oak file cabinet 1 3 85.00 85.00 12.75 72.25
Crib mattress 1 5 35.00 35.00 17.50 17.50
Baeball bag 1 2 24.99 24.99 5.00 19.99
RC R DEP NR DEP ACV
Subtotal 815.49 207.57 0.00 607.92
Tax 65.04 16.55 0.00 48.48
Contents Loss: 880.52 224.12 0.00 656.40
Totals: 5,739.12 649.74 0.00 5,089.38
Maximum Recoverable Depreciation 649.74
Total Loss 5,739.12
Less Deductible Applied 500.00
Total Claim 5,239.12
Less Recoverable Depreciation 649.74
ACV Claim 4,589.38
~r=atatl using ?owerClaim ~J. 1-d00 '2F-'~~19
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