2809 GRAND AVE 2022-04-18 - Laserfiche WebLink

11. If this claim Involves NIA OrAerS; Neme oarrerY insurance company a vehicle accident/colllslon, provide your vehlCle Inronnabon: Plate Ala r'air Ifodel Year DrtvuSS licem= M1'o. _—�-_ VchrJe onnerys) pfnllremrnNmm dmr) ---- Phone No. po";'Y a. 12. Names, addresses and telephone numbers of all persons Involved In or witness to this Incident: All named can be reached at 2009 Grand Avenue & 25-257.9500 Dusty Whltesell Arthur Laramv Kaydo Anderson Erika Barry, Krista Phillips Megan Carter, Kevin Phillips, Gabe eornman Adam Klemm Jerr1 Pettis Tiana Vassar. 13. Names, addresses and telephone numbers of all City of Everett employees having knowledge about this incident: We spoke to many people at the Public Works Department including but not limited to Chad in dispatch, Dan fan ns ectorl, Mark Ducetan Ins ector `andsiarla Carter Public Information &Education manager In the Public Works office via email. 14. Names, addresses and telephone numbers of all Individuals not already Identified In N12 and #13 above who have knowledge regarding the liability issues Involved In this Incident, or knowledge of the Claimant's resulting damages. Please Include a brief description as to the nature and extent of each person's knowledge. Attach additional sheets If necessary. Corey Brown Independent Claims Adjuster Adjusters Northwest 425-303-8123 We have also had a number of contractors out making bids and performing the work needed to make our business operational again. 15. Describe the cause of the Injury or damages. Explain the extent of property loss or medical, physical or mental Injuries. Attach additional sheets If necessary. The cause was the inability of the sewer systum to handle the amount of rain that fell the evening of August 30, 2013. The sewers began backing up at approximately 6pm and immediately black water surged out of sewer drains In the south half of our 18 000 square foot bull Ong, The sewage Quickly spread throughout a of our 3 collection floors our break room and all 5 offices in the south hair of the building. The water began Inundating t rye 3'a and larnest of our collection floors and only through the efforts of our employees were they able to beat back the surge and preserve a little space to enable us to do any work at all. The subsequent Inspection verified that black sewer water a Inundated our hrdlding and that we would need to have It professionally sanitized dried and rebuilt. Va have attempted to take pictures of everything as we go. The bottom 8-Inches of all drywall had to be cut, removed, and replaced All cubicles pods office partitions were disassembled and are being evaluated as to whether they can still be used. We are rtpable to accurately calculate the damage to our productivity based on having to relocate staff into extremely cramped Quarters at this time. 16. Has this Incident been reported to law enforcement, safety or security personnel? it so, when and to whom? 17. Names, addresses and telephone numbers of heating medical providers. Attach copies of all medical reports and billings. Rev. 07109