Claim White, Frederick D.CLAIM AGAINST THE CITY OF DUBUQUE, IOWA //z. ~&/~
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: Freder:ick D. White
2. Address: 1525 Lincoln Ave.
3. Telephone Number: 563-589-0813 (Day phone) 563-582-6532 (Night phone)
4. Date of Incident: December 26, 2001 First major problem
5. Time of Incident: N/A
6. Location of Incident (Be specific): Sewer drainpipe broken where it connects to the sewer
main under Lincoln Ave.
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.)
I believe it was caused from the work done on Lincoln Ave. several years ago. Many others on
Lincoln Ave. have experienced the same problem over the years since the street repair. The
latest that I know of is our neighbor two or three doors up on Lincoln. The City reimbursed her.
All the claimants felt the damage was caused from the work done when Lincoln was remodeled.
8. What were weather conditions like? ~/A
9. Give name and address of any witnesses: ~/A
10. Did police investigate? (If so, give names of officers.)
N/A
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
N/A
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.)
I have had sewer backup in our basement. During the most recent incident we needed to have
a plumber come to look at it at a cost of $85.86. He was not able to clear the drain. We then
had to get Roto-Rooter to clear the line,take his camera, and locate the problem. The cost was
$325.00. We may have to have him back as the sewer is backing up again.
13. What other damages do you claim, if any? we have ~ntten an estimate of what it will cost '
to make the necessary repairs to the drain. It has been estimated, if we can do the work before
the frost sets in, at $3200.00 ($2,250.00 tO dig up the street and replace the street, $450.00
for the drainpipe repairs, $300.00 for a tape & saddle to the main sewer.The cost will be higher
ifwe have to do it after the frost is in the zround.
14. Have you been compensated for any parr or all of your claim by any insurance
company? (If so, give name and address of insurance company and amount paid.)
No
15. What amount do you claim from the City of Dubuque?I am claiming the total cost of the
repairs, the plumbing COSts to date plus any necessary to keep~drain cleared until the
repairs are completed, and any health related costs.
16. Why dO you claim the City of Dubuque is responsible? This damage was not caused by
normal wear and tear. It was caused by work being done to Lincoln Ave. without regard
to what damage it may be causing to the sewer infrastructure. The rest of the drainpipe is
in good condition and I have not done anything to cause this type of damage.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
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 17
dayof January , 20 02
~ignature) ,
(Print Name)
(Rev. 1/00 & 7/01)
B.ALL PLUMBING AND HEA'I2NG
P,O. BOX 3235
DUBUQUE, IA 52004-3235
Invoice
DATE iNVOiCE ,ft-
12/26701 5173
BILL TO:
Fred White
1525 Linclon
Dubuque, IA. 52001
QUANTITY
DESCRIPTION
Clean a fllor drain.
1 Drain machine rental
1.5 Labor 1 man ~ $ 44.00 x 1.5 hrs.
Sales Tax
P.O. NUMBER
TERMS
Due on receipt
RATE
15.00
44.00
6.00%
PROJECT
AMOUNT
15.00T
66.00T
4.86
Thank you for your business TOTAL $85.86
PROPOSAL SUBMITTED TO:
PHONE NO. ~ - ARCHITECT
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~ons sustained for 8~ve ~k~d completed in ~ ~b~anti~l workmanlike ~fl~r Dr
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Resp~tfully submi~ed D~O
Any alteration or devi~ion from a~ve spe~fions involving e~m cos~
Note --This pmposat may be withdrawn
by us if not accepted within ~days.
PROPOSAL
MADE IN USA