Claim by Qwest due to Horsfield Const615 N Classen Blvd. Oklahoma City OK 73106 (800)421-2153 (405)606-8200 fax 290-2015 www.cmrclaims.com
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MRNRGEMENT *****NOTICE OF CLAIM*****
RE504RCE5
Date: 8/30/200 7 (~ O
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CERTIFIED MAIL RETURN RECEIPT REQUESTED
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To: CITY OF DEBUQUE S Ci3 LJ1 '~
CITY CLERK r_. ~;-
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CITY HALL ~ ~
50 WEST 13TH STREET y = N
DUBUQUE, IA 52001 ~ N
CERTIFIED MAIL # 9171082133393335790498
RE: Damage to QWEST Property
QWEST Claim No.: 428990
Date of Damage: 8/27/2007
Location of damage: 999 W 5TH, DUBUQUE, IA.
Amount of Damage Reimbursement Requested: $ 125.27 ESTIMATED, FURTHER INVOICES
PENDING
Dear Sir/Madam:
Please be advised that QWEST Facilities sustained damage as a result of the negligent acts by
employees or agents of the CITY OF DEBUQUE, IA.HORSFILD CONSTRUCTION INC.
Investigation has revealed that on or about 8/27/2007, employees or agents of the CITY OF
DEBUQUE, IA HORSFILD CONSTRUCTION INC. damaged A BURIED SERVICE WIRE
while doing HIGHWAY/STREET EXCAVATION WITH A CRAWLER in the area of 999 W
5TH, DUBUQUE, IA.
If there is insurance to cover this matter, kindly advise as to the name of the insurance
company, its address and the claim number assigned.
REQUEST FOR GOVERNMENTAL NOTICE FORM
If your Governmental Entity requires the completion of its own claim form to complete proper
notice, please forward a copy to the address above. Every good faith effort has been made to
identify the proper office and address to perfect our notice. Please forward to your attorney, if
misdirected, to contact us. Matters herein stated are alleged on information and belief this
pleader believes to be true.
If you have any questions, or need additional information, please contact me at \\~~~\~~Ill~fl~~~~~~
1-(800)-321-4158 EXT. 8232 or Fax: 405-606-3121. Please include the Qwest claim numb~r,~-E C'~V~` ~~~~i~
all correspondence. :~~~~',.~pTA/~y~S ~i
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Sin ely, = ~, # p6011463 1
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Kristy oop '~,9~~'••• ..............~~Q,`\~~`~
CMR QWEST CLAIMS NOTARY '%,,~ OF O \~~~~`
Commission Expires
615 N Clasen Blvd. Oklahoma City OK 73106 (800)421-2153 (405)606-8200 fax 290-2015 www.cmrclaims.com Gv
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MRNRGEMENT *****NOTICE OF CLAIM*****
RESOV RCES
Date: 8/30/2007
CERTIFIED MAIL RETURN RECEIPT REQUESTED
1b: CITY OF DEBUQUE
CITY CLERK
CITY HALL
50 WEST 13TH STREET
DUBUQUE, IA 52001
CERTIFIED MAIL # 9171082133393335790467
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RE: Damage to QWEST Property
QWEST Claim No.: 428936
Date of Damage: 8/27/2007
Location of damage: 986 W 5TH, DUBUQUE, IA.
Amount of Damage Reimbursement Requested: $ 725.00 ESTIMATED, FURTHER INVOICES
PENDING
Dear Sir/Madam:
Please be advised that QWEST Facilities sustained damage as a result of the negligent acts by
employees or agents of the CITY OF DEBUQUE, IA.HORSFILD CONSTRUCTION INC.
Investigation has revealed that on or about 8/27/2007, employees or agents of the CITY OF
DEBUQUE, IA HORSFILD CONSTRUCTION INC. damaged A BURIED CABLE while doing
HIGHWAY/STREET EXCAVATION WITH A BACKHOE in the area of 986 W 5TH,
DUBUQUE, IA.
If there is insurance to cover this matter, kindly advise as to the name of the insurance
company, its address and the claim number assigned.
REQUEST FOR GOVERNMENTAL NOTICE FORM
If your Governmental Entity requires the completion of its own claim form to complete proper
notice, please forward a copy to the address above. Every good faith effort has been made to
identify the proper office and address to perfect our notice. Please forward to your attorney, if
misdirected, to contact us. Matters herein stated are alleged on information and belief this
pleader believes to be true.
If you have any questions, or need additional information, please contact me at ~tlttlll111/~~~~
11(8orOresponden e. XT. 8232 or Fax: 405-606-3121. Please include the Qwest claim nu G~~Q,~ G~V~~~'''~
Si erely, ~` 'aoTARy'ti~s .'
#06011463 ~
- EXP.11/28l10
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Kristy Roop ,1 ' ~' ~ •'••............ ~ ~.
CMR QWEST CLAIMS NOTARY ~ F O K~,4'~~``
Commission Expires ~i~'n~~FllitOt~~~~~~~
615 N Clasen Blvd. Oklahoma City OK 73106 (800)421-2153 (405)606-8200 fax 290-2015 www.cmrclaims.com
C ~F1M~
MRNRGEMENT *****NOTICE OF CLAIM*****
RESOVRCES
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Date:8/30/2007 ~~ rn
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CERTIFIED MAIL RETURN RECEIPT REQUESTED
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To: CITY OF DEBUQUE ~~ C
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CITY CLERK `_ ~ ~
CITY HALL D ~ ;-
50 WEST 13TH STREET ~ ~
DUBUQUE, IA 52001 •r'
CERTIFIED MAIL # 9171082133393335790474
RE: Damage to QWEST Property
QWEST Claim No.: 428984
Date of Damage: 8/27/2007
Location of damage: 896 W 5TH, DUBUQUE, IA.
Amount of Damage Reimbursement Requested: $ 125.27 ESTIMATED, FURTHER INVOICES
PENDING
Dear Sir/Madam:
Please be advised that QWEST Facilities sustained damage as a result of the negligent acts by
employees or agents of the CITY OF DEBUQUE, IA.HORSFILD CONSTRUCTION INC.
Investigation has revealed that on or about 8/27/2007, employees or agents of the CITY OF
DEBUQUE, IA HORSFILD CONSTRUCTION INC. damaged A BURIED SERVICE WIRE
while doing HIGHWAY/STREET EXCAVATION WITH A CRAWLER in the area of 896 W
5TH, DUBUQUE, IA.
If there is insurance to cover this matter, kindly advise as to the name of the insurance
company, its address and the claim number assigned.
REQUEST FOR GOVERNMENTAL NOTICE FORM
If your Governmental Entity requires the completion of its own claim form to complete proper
notice, please forward a copy to the address above. Every good faith effort has been made to
identify the proper office and address to perfect our notice. Please forward to your attorney, if
misdirected, to contact us. Matters herein stated are alleged on information and belief this
pleader believes to be true.
~~~1\11111IflIU/
If you have any questions, or need additional information, please contact me at ,;~`~\\~.~1'E...G'~VF,~~~~i~
1-(800)-321-4158 EXT. 8232 or Fax: 405-606-3121. Please include the Qwest claim ~ CRY"'~s ~~~
all correspondence.
# p6011 ~ 0
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Kristy Roop i ~ %,,~rJ~OF'ft0```~~~
CMR QWEST CLAIMS NOTARY
Commission Expires
615 N Classen Blvd. Oklahoma City OK 73106 (800)421-2153 (405)606-8200 fax 290-2015 www.cmrclaims.com
C ~RIM~
MRNRGEMENT *****NOTICE OF CLAIM***** p
RESOURCES ~ J
I_t;=t~ - `3/30!2007 [~`< {~r7
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CERTIFIED MAIL RETURN RECEIPT REQUESTED ~ (lj ~ ~~
To: CITY OF DEBUQUE j ~~ a'
CITY CLERK `
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CITY HALL _
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50 WEST 13TH STREET ~ ~
DUBUQUE, IA 52001
CERTIFIED MAIL # 9171082133393335790481
RE: Damage to QWEST Property
QWEST Claim No.: 428986
Date of Damage: 8/27/2007
Location of damage: 996 W 5TH, DUBUQUE, IA.
Amount of Damage Reimbursement Requested: $ 125.27 ESTIMATED, FURTHER INVOICES
PENDING
Dear Sir/Madam:
Please be advised that QWEST Facilities sustained damage as a result of the negligent acts by
employees or agents of the CITY OF DEBUQUE, IA.HORSFILD CONSTRUCTION INC.
Investigation has revealed that on or about 8/27/2007, employees or agents of the CITY OF
DEBUQUE, IA HORSFILD CONSTRUCTION INC. damaged A BURIED SERVICE WIRE
while doing HIGHWAY/STREET EXCAVATION WITH A BACKHOE in the area of 996 W
5TH, DUBUQUE, IA.
If there is insurance to cover this matter, kindly advise as to the name of the insurance
company, its address and the claim number assigned.
REQUEST FOR GOVERNMENTAL NOTICE FORM
If your Governmental Entity requires the completion of its own claim form to complete proper
notice, please forward a copy to the address above. Every good faith effort has been made to
identify the proper office and address to perfect our notice. Please forward to your attorney, if
misdirected, to contact us. Matters herein stated are alleged on information and belief this
pleader believes to be true.
If you have any questions, or need additional information, please contact me at ~~~~~`t\\\t~E"G/,~~~~~~ii
1-(800)-321-4158 EXT. 8232 or Fax: 405-606-3121. Please include the Qwest claim nu~~~. .VFiV ~ii~
' all correspondence. r" '~O~'~l'~'~,~ '~
Since ly, #06011463 ,s
:EXP. 11/28/10 = Q
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Kristy op ~ OF O`~`~'P~~~
CMR QWEST CLAIMS NOTARY r/hri~~ilttN~~~
Commission Expires
615 N Clasen Blvd. Oklahoma City OK 73106 (800)421-2153 (405)606-8200 fax 290-2015 www.cmrclaims.com
C ~RIM~
MRNRGEMENT *****NOTICE OF CLAIM*****
RESOVRCES
Date: 8/30/2007
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CERTIFIED MAIL RETURN RECEIPT REQUESTED ~`~ ~
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To: CITY OF DEBUQUE r`~ 1
CITY CLERK ~ %' ~ -n
CITY HALL ~ ~~' ~ ,~
50 WEST 13TH STREET ~ O _, f-R
DUBUQUE, IA 52001
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CERTIFIED MAIL # 9171082133393335790504 ~'
RN;: Damage to QWEST Property
is ~~ iJ ~ L' Claim No.: 428991
Date of Damage: 8/27/2007
Location of damage: 995 W 5TH, DUBUQUE, IA.
Amount of Damage Reimbursement Requested: $ 125.27 ESTIMATED, FURTHER INVOICES
PENDING
Dear Sir/Madam:
Please be advised that QWEST Facilities sustained damage as a result of the negligent acts by
employees or agents of the CITY OF DEBUQUE, IA.HORSFILD CONSTRUCTION INC.
Investigation has revealed that on or about 8/27/2007, employees or agents of the CITY OF
DEBUQUE, IA HORSFILD CONSTRUCTION INC. damaged A BURIED SERVICE WIRE
while doing HIGHWAY/STREET EXCAVATION WITH A BACKHOE in the area of 995 W
5TH, DUBUQUE, IA.
If there is insurance to cover this matter, kindly advise as to the name of the insurance
company, its address and the claim number assigned.
REQUEST FOR GOVERNMENTAL NOTICE FORM
If your Governmental Entity requires the completion of its own claim form to complete proper
notice, please forward a copy to the address above. Every good faith effort has been made to
identify the proper office and address to perfect our notice. Please forward to your attorney, if
misdirected, to contact us. Matters herein stated are alleged on information and belief this
pleader believes to be true.
If you have any questions, or need additional information, please contact me at
1-(800)-321-4158 EXT. 8232 or Fax: 405-606-3121. Please include the Qwest claim
all correspondence.
Sinc ely,
Kristy Roop
CMR QWEST CLAIMS
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