Claim by University of Dubuque_Kloft vgcki
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. You should p
complete this form in full and attach any additional information that supports your claim. I
�
The Claim must be filed with the City Clerk at City Hall, 50 W. 131" St., Dubuque, IA 52001. It
U
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
t
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 k
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: University of Dubuque ( Craig Kloft Director of Facilities )
i
2. Address: 2000 University Ave
3. Telephone Number: 563-589-3251
4. Date of Incident: October 27
!I
5. Time of Incident: 3:00pm
6. Location of Incident (Be specific): 97A & 97B Collins Street, lower level bedroom, landing j
area, storage room. See attachment
i
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.)
Main sewer line on Collins street had water coming out of the top. This cause the back up into h'
I�
97A & 97B
8. What were weather conditions like? Good
9. Give name and address of any witnesses: C.J. Beekman with Mr. Rooter Plumbing
10. Did police investigate? (If so, give names of officers.)
No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
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.)
Clean up cost, carpet removal and replacement. See attachments
13. What other damages do you claim, if any? None
k
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.)
No
Ih
15. What amount do you claim from the City of Dubuque? 4
100%
'i
16. Why do you claim the City of Dubuque is responsible?
The city should be responsible to keep main sewer line open
i
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
2
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
i
Dated at Dubuque, Iowa this aO day of 6/;j 20 .
I
(Signature)
U/J ` / � �" (Print Name)
CD
(Rev. 7/12) U r
` M
On October 27, the city sewer backed up into the basements of two units owned by
University of Dubuque. Unit 97Bhad minimal cleanup only, but unit 97A the carpets in a
bedroom, landing area, and four area rugs from the basement
were destroyed, removed, and discarded. Currently our expenses include $1,943.00
from St"I uratic for removal of sewage contaminants, cleanup and disinfecting, Mel's
Carpet $446.00 for replacement of flooring, and Mr. Rooter $165.00. At this point, we
have not yet received an invoice from tenant on the replacement cost of their personal
area rugs. Attached are the above-mentioned invoices.
J
Craig Kloft
Director of Facilities
University of Dubuque
i
{
I
,I
'I
i
II
ii
I
i
i