Claim Turner, Jerry/ EcksteinCLAIM 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 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: Jerry Turner for Judy Eckstein
2. Address: 2230 White St. Dubuque
3. Telephone Number: 583 0657
4. Date of Incident: 4/3/02
5. Time of Incident: 2:00 P.M.
6. Location of Incident (Be specific): Basement Bathroom
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.)
While White Street was being repaired a Sewer Line was broken and caused Raw Sewage to back up in the basement of 2230 White
8. What were weather conditions like?
Clear and Sunny
9. Give name and address of any witnesses:
Tim Latner, City Employee
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.)
Fooring in bathroom ruined & carpeting ruined.
13. What other damages do you claim, if any?
Clear-up and replacement of Floor & Carpeting.
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.
15. What amount do you claim from the City of Dubuque? $1,676.90
Sixteen Hundred and seventy-six dollars and 90 cents.
16. Why do you claim the City of Dubuque is responsible?
The construction company shall be responsible - Stewart Construction.
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 25th day of April, 2002. , 20 .
/s/ Jerry Turner
29557 250th Ave.
LaMotte, Iowa 52054
(563 773 8445
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. You si
complete this form in full and attach any additional information that supports your clair
The Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA '~2001.
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 AUTHORIT~ TO MAKE ANY REPRESENTATION TO
YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant:
/
2. Address: ~-'-~ .-.~-. _ ~',"2
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
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.)
8. What were weather conditions like? ~_~ Z
9. Give name and address of any witnesses: '7-~.~ }.~ 7-,~,~ c ,7,7 ~.,.,p zo?.~_~
10. Did police investigate? (If so, give names of officers.)
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 extent of damage.)
13. What other damages do you claim, if any? ~/¢~,- ~.p a R~?X.~,~ ~ .~.~- ~
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.)
15. What amount do you claim from the City of Dubuque? '~ ~ ~/..
16. Why do you claim the City of Dubuque is responsible? 5~Y~
~d
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated atrDubu~.que, Iowa this
0 ~
(Signature)
'(Print Name)
(Rev. 1/00 & 7/01)
SERVICE FOR:
Jerry Turner
BILL TO:
Jerry Turner
INVOICENUMBER
ORDER NUMBER
TAX NUMBER
JOB DESC~PTION
DATE
Turner02
Installation of ceramic and
carpet. All prep and
materials.
19 April 02
DATE
19April
SERVICE DESCRIPTION
Carpet Installation
Carpet Prep
Re glue vct tile ( keeping floor at one
consistency)
Steps
Bathroom
Tile and materials
Floor leveler
Pulling of Toilet and reset
Seal ( with flang)
Waterline ( supply line )
Installation and material for Trim
MAKE CHECKS PAYABLE TO:
TJ Tile Co.
HOURS RATE AMOUNT
lchrg
lchrg
lchrg
lchrg
lchrg
lchrg
lchrg
lchrg
1 ch rg
1 chrg
200.00
60,00
25.00
35.00
6o.0o[
25.00!
250.00 250.00
50.00 50~001
40.00 40.00
6.5o! 6.5o
12.00i 12.00
55.00! 55.00
$73~,:$~
TOTAL DUE
TJ Tile Co.
2424 Windsor Ave
Dubuque, IA 52001
Ph: 563-556-3;'40
Carpet Billing Statement
SERVICE FOR:
Jerry Turner
Apt. on White st.
INVOICE NUMBER!Turner02
ORDER NUMBER i
TAX NUMBER [
t
JOB DESCRIPTION Sale of commercial carpe
DATE 18Apri 02
!BILL TO:
Jerry Tumer
DATE
18Apd102
Goods and Conditions
Commercial Grade Carpet ( Tan, Beige)
Amount Pricin AMOUNT
1 Rerr 340.00 340.00
MAKE CHECKS PAYABLE TO:
TJ Tile Co.
TAX
lchrgi
20.40'
20.40
$360.40
TOTAL DUE
I TEAMATIC®
Dubuque Area Steamatic, Inc.
500 Huff'St.
P.O. Box 1164
Dubuque, IA 52004-1164
563-556-5821
BILL TO
Jerry Turner
i 29447 250th. Ave.
LaMoUe, IA. 52054
Invoice
DATE INVOICE
4/9/2002 [ 11085
L P O NO. ~ TERMS [ DUE DATE Ii REP _
.... iT-~ ~ DESCRIPTION i SERVICE DATE I AMOUNT
Resmrmion from sewage at 2230 ~ite St, Dubuque, , ; I
~ 235.00
30 l g5-WA~R R ~ Remove ~ m domars be~m, ba~ ~d closet ~d d~s~se ~ 4/3/2002
~ of ] 180.00
30 t gS-WA~R R [ PI~ l dehmi~fi~ ~ 45.00 ~r day ~ 4 ~ys [ 4/3/2002 59.00
30185-WA~R R ~ Spray Mi~ob~ disinfect on ~1 ~ s~s [4/5/2002 109.00
30185-WATER R i Cle~ md s~iti~ fll fl~s aff~& cle~ hath fix~es ~d cl~
~t in kitchen 0.00
Non T~le Sale
~xxrX o.~.lhto vm~rhuslness. Thank you.