Hemrick, JoeyRevised March 2023
NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota
Minnesota State Statute 466.05 states that “…every person…who claims damages from any municipality…shall cause to be presented to the governing body of the
municipality within 180 days after the alleged loss or injury is discovered a notice stating the time, place, and circumstances thereof, and the amount of compensation
or other relief demanded.”
Please complete this form in its entirety by clearly typing or printing your answers to each question. If you have additional documentation, you may add those
documents to your submission. You will not be contacted by telephone unless clarification is needed. The claim process for investigations can take upwards of four (4)
weeks. This form must be signed, dated with all applicable sections completed. Submission this completed form to the Saint Paul City Clerk’s Office by email
(cityclerk@ci.stpaul.mn.us), fax (651-266-8574) or mail addressed to “Saint Paul City Clerk, 15 West Kellogg Blvd., Suite 310, Saint Paul, MN 55102”.
Claimant: First Name: Joey_____________________________ Last Name: Hemrick________________________________________
Please Indicate Your Pronouns: ☒ She/Her/Hers, ☐ He/Him/His, ☐ They/ Them/Theirs
Company or Business Name: Afni_________________________________________________________________________________
Is this claim being made by an Insurance Company? YES / NO If yes, what is your Claim/File Number? 5340133_________________
Is this claim being made by an Attorney? YES / NO If yes, what is your File Number? NO____________________________________
If yes, provide your Insured’s/ Client’s Name: Deborah & Richard Millerbernd_____________________________________________
Street Address: 420 21st Ave S___________________________________________________________________________________
City: South Saint Paul_________________________________ State: MN_____________________ Zip Code: 55075-2119_________
Daytime/Work Phone: (309) 831-2972______________________ Cell Phone: _____________________________________________
Date of Incident or Date Discovered (Must Complete): 1/12/2025 Time: 12:01 AM_________________________________________
Please state, in detail, what happened that prompted you to file a Notice of Claim Form: City’s sewer system got plugged up and all
sewer came through drain into the finished basement._______________________________________________________________
Please state why or how you feel the City of Saint Paul is responsible for your Damages? Clog in city sewers cleared by city_________
Please check the reason that most closely describes the reason for your submitting a claim. Please note the documents that will
need to be provided with your completed form. Photographs will be accepted. All documents submitted become the property of
the City of Saint Paul and shall not be returned.
☐ Automobile damage from a motor vehicle accident: please provide two estimates for repairs or actual bill that has been paid.
☐ Automobile damage from a street defect or pothole: please provide two estimates for repairs or actual bill that has been paid.
☐ Automobile was towed and may or may not have sustained damage: please provide copy of towing ticket (if available), receipt
from Impound Lot, and two estimates for repairs or actual bill that has been paid.
☐ Snow Emergency: please provide copy of towing ticket (if available), receipt from Impound Lot, and two estimates for repairs or
actual bill that has been paid.
☒ Property damage: please provide two estimates for repairs or actual bill that has been paid.
☐ You were injured during a motor vehicle accident: please provide police report number, details about injury.
☐ You were injured in the City of Saint Paul: please provide police report number, witnesses, and details about injury.
Continue to page 2 of Notice of Claim Form. Failure to complete and return both pages will result in delays.
Revised March 2023
This section must be completed for all claims.
Is there a police report for this incident? NO
If yes, please provide the police report case number: ___________________________
If yes, what law enforcement agency responded? ____________________________________________________________
Where did the incident take place? Please provide a street address, intersection or name of city park or facility:
420 21st Ave S South Saint Paul, MN 55075-2119____________________________________________________________________
What would you like to see happen to resolve this claim to your satisfaction? Reimbursement for mitigation and repairs__________
Were there witnesses to this incident? Please provide names and contact phone numbers:
NO_________________________________________________________________________________________________________
For property damage claims, including vehicle accidents.
Your vehicle’s information: Year: _________ Make: _________________ Model: __________________ Color: __________________
License Plate #: _________________________ State vehicle is registered in: ___________________________
Registered owner of vehicle: _____________________________ Driver: __________________________________________
Area(s) damaged:______________________________________________________________________________________
If a City vehicle was involved, License Plate #: _________________________________ Color: _______________________________
Was there City insignia on the vehicle? YES / NO Driver’s Name: ______________________________________________________
Other property damaged: Water damage to Finished basement. Bathroom, laundry room, furnace room, small closet, and main
room________________________________________________________________________________________________________
For injury claims of any type.
What part of your body was injured? _____________________________________________________________________________
Did you go to the emergency room or urgent care? YES / NO Where? ___________________________________________________
Was medical treatment received? YES / NO Where? ________________________________________________________________
First day of medical treatment? _____________ Are you still receiving medical treatment? YES / NO
Did you miss any work as result of this incident? YES / NO
Employer(s): _________________________________________________________________________________________________
How much time have you missed from work? _____________________________________________________________________
If you are submitting other documents, please state what you are attaching and how many pages: _________________________
By signing this form, you agree that all information provided is true and correct to the best of your knowledge.
Please NOTE that submitting a false or misleading claim can and will result in prosecution under Minnesota Statutes.
Name of Person completing form: Joey Hemrick, Afni_____________________________________________________________
Signature of Person submitting this form: Joey Hemrick____________________________________________
Relationship of person signing to Party making the claim: Insurance Company Representative
Revised March 2023
Date document is being signed: 3/20/2025
Claim: 0002624519
Pol: WNP - 250966XClaim #: 0002624519Policy St: RenewalIns: DEBORAH & RICHARD MI...DoL: 01/12/2025Adj: Kaitlyn
Burkett (Property 1 Inside D)Sup: Sarah Bell
Financials: Payments
Issue Date Check
Number
Pay To Amount Feature Coverage Scheduled
Send Date
Period
Start Date
Period
End Date
Cost Type Cost
Category
Primary
Status
Pmt Type
01/24/2025 0020373066 ALACRITY
PARENT, LLC
$350.00 1 Backup of
Sewer or
Drain
01/24/2025 Adjusting
& Other
Expense
General Submitted Partial
02/13/2025 0020377593 DEBORAH
& RICHARD
MILLERBERND
$12,791.66 1 Backup of
Sewer or
Drain
02/13/2025 Claim
Cost
General Submitted Partial
02/13/2025 0020377592 DEBORAH
& RICHARD
MILLERBERND
$1,520.22 2 Backup of
Sewer or
Drain
02/13/2025 Claim
Cost
General Submitted Partial
03/05/2025 0020382116 Summit Auditing
LLC
$321.42 1 Backup of
Sewer or
Drain
03/05/2025 Adjusting
& Other
Expense
General Submitted Partial
03/05/2025 0700527562 24RESTORE
INC & DEBORAH
& RICHARD
MILLERBERND
$6,761.99 1 Backup of
Sewer or
Drain
03/05/2025 Claim
Cost
General Submitted Partial
03/05/2025 0020382127 DEBORAH
& RICHARD
MILLERBERND
$300.00 1 Backup of
Sewer or
Drain
03/05/2025 Claim
Cost
General Submitted Final
User: Austin Pena Page 1 Mar 10, 2025 3:56 PM
Insured:
Loss Date:
Sales Tax:
Millerbernd
1/12/2025
8.125%
Date:
Company:
Adjuster:
Adjuster Phone:
1/31/2025
Westfield Insurance Group
Amanda Peebles
(800) 243-0210 x4306462
SALN/Claim#:0002624519
Powered by TrueLKQ®
Property Details
Building:Room:Residence Basement
Item
Qty
Orig/
Repl
Item Description
Original/Like Kind Quality/Source*/Limit/Notes
Age
Yrs/Mos
Settlement
Action
Repl Cost
Each
Repl Cost
Total Dep% Total
Dep Amt
Total ACV Total
1 1/1 video slot machine base/
https://www.mercari.com/us/item/m85755895660/
?
srsltid=AfmBOoqSLnb3tUjETJkK0YRxVWN3M6i
GIxTQk2UY3qCJ9O1tAshbc5qqFMo
5/0 Depreciate 324.38 324.38 25.01 %81.10 243.28
2 1/1 52 inch poker table/
8005B14F193E4D02AF4B497213E3AF "Alandria
48"" 4 - Player Poker Table"/ Wayfair
15/0 Depreciate 865.00 865.00 25.00 %216.25 648.75
3 1/1 PAC Man video game/
https://www.walmart.com/ip/Arcade1UP-Pac-
Man-Head-to-head-H2H-12-Games-in-1-Gaming-
Table-w-Lit-Deck/560609591?
wmlspartner=wlpa&selectedSellerId=1187&sourc
eid=dsn_ad_82a1172e-9aef-4deb-a6c1-
b1278a1d5253&veh=dsn&wmlspartner=dsn_ad_
82a1172e-9aef-4deb-a6c1-b12
4/0 Depreciate 648.74 648.74 25.01 %162.19 486.55
4 3/3 bathroom rug/ 03731874102039 Absorbent &
Non-Slip Luxury Chenille Bathroom Rug/ Bed
Bath & Beyond
4/0 Depreciate 25.07 75.21 24.02 %18.06 57.15
5 1/1 shower curtain/ 3027024SC Evergreen Shower
Curtain Shower Curtain/ Wayfair
4/0 Depreciate 37.83 37.83 24.01 %9.08 28.75
6 1/1 Shower curtain liner/ TSRYL020120078496
Tiramisubest Shower Curtain Liner/ Wayfair
1/0 Depreciate 20.53 20.53 6.00 %1.23 19.30
7 1/1 Laundry room rug/ Ottomanson WTN7704-2X5
Machine Washable Non-Slip Rubberback
Laundry Room Runner Rug, Entryway Rug/
Wayfair
0/1 Depreciate 36.44 36.44 0.00 %0.00 36.44
Residence / Basement Totals 2,008.13 487.91 1,520.22
² Item can be replaced at the stated cost by visiting the ReStore Mall at https://www.restoremall.com and clicking ‘Get Started Now’ to set up an account. Once
signed in, search for your items on the mall. For items that you cannot find or for general assistance using the ReStore Mall, please call 1-855-836-6731 Monday
through Friday from 8am-8pm Eastern Time.
Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.
Printed: 1/31/25 9:14:31 AM
Page 3 of 4
INVOICE
1/31/2025
Invoice #
25-0257-MIT
Bill To:
Rich Millerbend
420 21st Ave S
South Saint Paul, MN 55075
USA
24Restore
6250 McKinley St. NW
Ramsey, MN 55303
P.O. No.
250061
Terms
Net 10
Due Date
2/10/2025
Phone #
763-753-8080
Fax #
763-753-2505
Balance Due
Balance Due
Subtotal
Sales Tax (8.125%)
Pymts/Credits
PLEASE DETACH AND RETURN TOP PORTION WITH
YOUR PAYMENT.
Please check box if address is incorrect or has changed, and indicate
change(s) on reverse side.
VISA / MasterCard / Discover / American Express
Accepted
24Restore
6250 McKinley St NW
Ramsey, MN 55303
FED ID TAX : 41-1863217
Please endorse any insurance checks and mail to 24Restore. If
check includes mortgage, please contact 24Restore.
Date
TotalAfter 30 days finance charges of 10% will be applied. Credit and Debit card
payments will incur a 3% convenience fee. Please contact our office if you
would like a detailed breakdown of this invoice or have any other questions at
(763-753-8080)
Thank you for your business!
Item Description Class Amount
Mitigation Water Damage: Mitigation Services FC Water 5,919.14T
Mitigation Water Damage: Mitigation Services - Nontaxable FC Water 1,635.35
Payment of $300.00 applied to invoice
$7,735.42
$7,554.49
$480.93
$8,035.42
$7,735.42
-$300.00
1
24Restore
-Fire-Water-Storm-Environmental-
"The People, The Equipment, The Expertise"
6250 McKinley St NW, Ramsey, MN 55303
Tax ID# 41-1863217 www.24restore.com
Client:Millerbend, Rich Home:(651) 308-6871
Property:420 21st Ave S
South St. Paul , MN 55075
Operator:TIFFA
Estimator:Tiffany Stroman Business:(612) 424-2424
E-mail:tiffany@24restore.comCompany:24Restore
Business:6250 McKinley St NW
Ramsey, MN 55303
Type of Estimate:Water Damage
Date Entered:1/28/2025 Date Assigned:
Price List:MNMN8X_JAN25
Labor Efficiency:Restoration/Service/Remodel
Estimate:25_MILLERBEND_R_MIT
Upon assessment on 1/13/2025, the crew found water damage that appeared to be caused by a sewage backup from the
city affecting the basement laundry room, utility room, storage room, bathroom and living room. Affected materials
include drywall, tile, framing and concrete. This was a category 3 water loss requiring 10 days for drying.
Full room scans and additional photos are provided in our docusketch tour link below for you to reference.
360° Tour Link: https://app.docusketch.com/player/BhrGslXx
This document serves as the detailed breakdown of the invoice to follow from our accounting department. This reflects the work
that HAS been completed and is being billed as such.
If we don't hear from insurance or the property owner with questions or issues within 10 days of this being sent, we will assume
it is approved in its current form.
Thank you for choosing 24Restore,
Tiffany Stroman
This estimate does NOT reflect any credits or payments applied to the account.
2
24Restore
-Fire-Water-Storm-Environmental-
"The People, The Equipment, The Expertise"
6250 McKinley St NW, Ramsey, MN 55303
Tax ID# 41-1863217 www.24restore.com
25_MILLERBEND_R_MIT 1/31/2025 Page: 2
25_MILLERBEND_R_MIT
Laundry Room
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
1. Water Extraction & Remediation 0.50 HR 0.00 84.77 3.44 45.83
Technician - per hour
Labor for mopping and cleaning sewage.
2. Washer/Washing machine - Detach 1.00 EA 0.00 42.39 3.44 45.83
Detach washer to allow for mitigation process.
3. Dryer - electric - Detach 1.00 EA 0.00 32.69 2.66 35.35
Detach dryer to allow for mitigation process.
4. Tear out trim and bag for disposal -54.00 LF 1.36 0.00 0.83 74.27
up to Cat 3
Removed trim to expedite drying process.
5. Interior door slab only - Detach 1.00 EA 0.00 10.07 0.82 10.89
Detach door to access door casing.
6. Tear out wet drywall, cleanup, bag -15.00 SF 2.05 0.00 0.21 30.96
Cat 3
Removed drywall to expedite drying process.
7. Tear out baseboard and bag for 18.00 LF 1.36 0.00 0.28 24.76
disposal - up to Cat 3
Removed baseboard to expedite drying process.
8. Tear out and bag wet insulation -13.00 SF 1.58 0.00 0.07 20.61
Category 3 water
Removed insulation to expedite drying process.
9. Remove polyethylene vapor barrier -13.00 SF 0.23 0.00 0.00 2.99
Category 3
Removed vapor barrier to expedite drying process.
10. Apply plant-based anti-microbial 31.00 SF 0.00 0.41 1.03 13.74
agent to the surface area
Plant based anti-microbial applied to affected to prevent mold growth throughout the dry out process.
11. Air mover (per 24 hour period) -32.00 EA 0.00 28.00 72.80 968.80
No monitoring
4 air movers placed 1/13 - 1/20, all removed 1/21.
12. Dehumidifier (per 24 hr period) -8.00 EA 0.00 80.81 52.53 699.01
70-109 ppd - No monitor.
One LGR DRY MAX dehumidifier on 1/13 - 1/20 to counteract high humidity levels, removed 1/21.
Totals: Laundry Room 138.11 1,973.04
3
24Restore
-Fire-Water-Storm-Environmental-
"The People, The Equipment, The Expertise"
6250 McKinley St NW, Ramsey, MN 55303
Tax ID# 41-1863217 www.24restore.com
25_MILLERBEND_R_MIT 1/31/2025 Page: 3
Utility Room
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
13. Water Extraction & Remediation 0.25 HR 0.00 84.77 1.72 22.91
Technician - per hour
Labor for mopping and cleaning sewage.
14. Air mover (per 24 hour period) -10.00 EA 0.00 28.00 22.75 302.75
No monitoring
1 air mover placed 1/13 - 1/22, removed 1/23.
15. Dehumidifier (per 24 hr period) -2.00 EA 0.00 80.81 13.13 174.75
70-109 ppd - No monitor.
One LGR DRY MAX dehumidifier on 1/21 - 1/22 to counteract high humidity levels, removed 1/23.
16. Negative air fan/Air scrubber (24 3.00 DA 0.00 78.56 19.15 254.83
hr period) - No monit.
Air scrubber used from 1/20 to 1/22, removed on 1/23. Air scrubber needed per the IICRC S500, Fifth Edition 2021, Section 12.5.3
Controlling Airflow. Final paragraph states “Where cleaning cannot sufficiently remove soil or particulates, when airflow is directed
through interstitial spaces, or there are high-risk occupants, it is recommended restorers install one or more air filtration devices (AFDs)”
Interstitial spaces in a home are any areas that don’t allow general occupancy, this includes but is not limited to, wall cavities, floor cavities,
ceiling cavities, attic/crawlspaces, under/behind cabinets or other units/items attached to the home. These areas can’t be properly cleaned to
remove particulates especially when still wet and will typically cause the particulates to become aerosolized once they dry.
Totals: Utility Room 56.75 755.24
Living Room
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
17. Water Extraction & Remediation 1.00 HR 0.00 84.77 6.89 91.66
Technician - per hour
Labor for mopping and cleaning sewage.
18. Tear out trim and bag for disposal -161.00 LF 1.36 0.00 2.49 221.45
up to Cat 3
Removed trim to expedite drying process.
19. Tear out wet drywall, cleanup, bag -22.00 SF 2.05 0.00 0.30 45.40
Cat 3
Removed drywall to expedite drying process.
20. Tear out cabinetry - vanity and 3.00 LF 17.54 0.00 0.00 52.62
countertop
Removed cabinetry to expedite drying process.
21. Tear out non-salv vinyl, cut & bag -296.00 SF 3.18 0.00 1.68 942.96
Category 3 water
Removed vinyl flooring to access subfloor.
22. Water extraction from hard surface 20.00 SF 0.00 0.96 1.56 20.76
floor - Cat 3 water
4
24Restore
-Fire-Water-Storm-Environmental-
"The People, The Equipment, The Expertise"
6250 McKinley St NW, Ramsey, MN 55303
Tax ID# 41-1863217 www.24restore.com
25_MILLERBEND_R_MIT 1/31/2025 Page: 4
CONTINUED - Living Room
DESCRIPTION QTY REMOVE REPLACE TOTALTAX
Removed water on vinyl flooring.
23. Air mover (per 24 hour period) -23.00 EA 0.00 28.00 52.33 696.33
No monitoring
3 air movers placed on 1/13 - 1/19, 1 removed 1/20, all removed 1/21.
24. Dehumidifier (per 24 hr period) -8.00 EA 0.00 80.81 52.53 699.01
70-109 ppd - No monitor.
One LGR DRY MAX dehumidifier on 1/13 - 1/20 to counteract high humidity levels, removed 1/21.
25. Negative air fan/Air scrubber (24 7.00 DA 0.00 78.56 44.68 594.60
hr period) - No monit.
Air scrubber used from 1/13 to 1/19, removed on 1/20. Air scrubber needed per the IICRC S500, Fifth Edition 2021, Section 12.5.3
Controlling Airflow. Final paragraph states “Where cleaning cannot sufficiently remove soil or particulates, when airflow is directed
through interstitial spaces, or there are high-risk occupants, it is recommended restorers install one or more air filtration devices (AFDs)”
Interstitial spaces in a home are any areas that don’t allow general occupancy, this includes but is not limited to, wall cavities, floor cavities,
ceiling cavities, attic/crawlspaces, under/behind cabinets or other units/items attached to the home. These areas can’t be properly cleaned to
remove particulates especially when still wet and will typically cause the particulates to become aerosolized once they dry.
Totals: Living Room 162.46 3,364.79
Bathroom
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
26. Water Extraction & Remediation 0.25 HR 0.00 84.77 1.72 22.91
Technician - per hour
Labor for mopping and cleaning sewage.
27. Air mover (per 24 hour period) -2.00 EA 0.00 28.00 4.55 60.55
No monitoring
2 air movers placed 1/13, removed 1/14.
Totals: Bathroom 6.27 83.46
General Items
DESCRIPTION QTY REMOVE REPLACE TAX TOTAL
28. Floor protection - cloth - skid 60.00 SF 0.00 1.38 6.73 89.53
resistant, breathable
Cover the floor in general traffic areas to protect unaffected flooring.
29. Emergency service call - during 1.00 EA 0.00 246.67 20.04 266.71
business hours
This item covers additional costs that are not listed above. It is in reference to the indirect costs incurred when re-directing and dispatching
a crew to the loss site for an initial visit. This includes the cost of generating reports.
5
24Restore
-Fire-Water-Storm-Environmental-
"The People, The Equipment, The Expertise"
6250 McKinley St NW, Ramsey, MN 55303
Tax ID# 41-1863217 www.24restore.com
25_MILLERBEND_R_MIT 1/31/2025 Page: 5
CONTINUED - General Items
DESCRIPTION QTY REMOVE REPLACE TOTALTAX
30. Equipment setup, take down, and 14.00 HR 0.00 84.77 96.43 1,283.21
monitoring (hourly charge)
2 hour minimum each day of monitoring with drying logs, includes equipment set-up on the first day and pick up on the final day. Service
Date(s): 1/13, 1/14, 1/16, 1/17, 1/20, 1/21 and 1/23.
31. Haul debris - per pickup truck load 1.00 EA 219.44 0.00 0.00 219.44
- including dump fees
Haul away and dispose of debris.
Totals: General Items 123.20 1,858.89
Line Item Totals: 25_MILLERBEND_R_MIT 486.79 8,035.42
6
24Restore
-Fire-Water-Storm-Environmental-
"The People, The Equipment, The Expertise"
6250 McKinley St NW, Ramsey, MN 55303
Tax ID# 41-1863217 www.24restore.com
25_MILLERBEND_R_MIT 1/31/2025 Page: 6
Summary
Line Item Total 7,548.63
Matl Sales Tax Reimb 5.86
Subtotal 7,554.49
Cleaning Sales Tax 480.93
Replacement Cost Value $8,035.42
Net Claim $8,035.42
Tiffany Stroman
We appreciate the opportunity to be of service to you.
(1) The accuracy of this assessment is limited to what we are able to inspect visually. This estimate and scope of work represents
our professional opinion to restore the property to "pre-loss" condition and in no way reflects any interest or impact on a final
settlement.
(2) Line items include a description of work to be done, the unit of measurement and quantity needed. Please note: these work
descriptions are maintained on a computer data base accepted by your insurance company and may not accurately describe the
actual work to be completed but most closely reflects the real cost.
(3) Open items: Often it is not possible to tell, prior to work starting, if items scheduled to be cleaned will indeed clean or if there
is concealed damage. Also, mechanical trade bids (plumbing, electrical, and HVAC) are often not possible to bid before demo is
complete. Open items and concealed damage will automatically be presented to your insurance adjuster and added to the contract
amount.
(4) To satisfy the needs of the insurance industry, this estimate is written to provide a specific scope of work at a package price.
Individual line item pricing includes various job cost items like; material, labor, soft costs, burden, and associated work. Material
allowances will be provided on a separate format. Due to administrative cost, work deletions and changes in the work will result
in only a partial credit or may not be allowed.
WORK PROCESS
(1) In accordance with federal law, if your home was built before 1978, you may be entitled to a pamphlet explaining possible
construction risks involving lead based paints.
(2) In the demolition process, any damaged materials or items removed will become the property of contractor unless other
arrangements are made prior to contract signing.
(3) The repair process can be a dusty, dirty job at times, and even with all precautions taken, some dust will accumulate at times.
Please take caution to protect your possessions and bear with us.
(4) You are responsible for your possessions and valuables. We will have workmen visiting your home. You must secure and
protect all valuables, pets, firearms, decorations, antiques, and furnishings.
(5) Due to trade scheduling, material deliveries, and changing weather, there will be times when no workmen are on your job
site. This is a normal part of the process and should be no cause for no alarm. We will make every attempt to keep you informed
of all construction schedules.
(6) Restoration work sometimes requires chemicals, biocides, or procedures to help control smoke odor, mold, etc., that
7
24Restore
-Fire-Water-Storm-Environmental-
"The People, The Equipment, The Expertise"
6250 McKinley St NW, Ramsey, MN 55303
Tax ID# 41-1863217 www.24restore.com
25_MILLERBEND_R_MIT 1/31/2025 Page: 7
sometimes give off a foul smell or possibly dangerous off-gases. Paint or finishes may also give off strong or pungent odors.
With good ventilation, these should dissipate quickly. Exposure should be kept to a minimum or avoided, and people with health
issues should refrain from any exposure. Remember, your property is now a construction site, and should be treated as such. If
you have any concerns, Contact your Project Manager before entering the property.
(7) State, City, or County building codes, at times, require additional work or changes for the safety of the occupant or public.
The cost of code upgrades are not included in this estimate, may not be covered by your insurance policy, and are you
responsibility. Consult you policy or claims representative for clarification. We may not know of these items until inspections;
however, we will notify all parties of any upgrades needed prior to work commencing. Additionally, codes or individual
inspectors may require relocation of outlets, switches, heat ducts, doors, windows, plumbing, or other work contrary to what is
shown in the scope of work.
(8) Pre-existing damages or conditions to the property not related to this loss are not included in this scope or work and/or
contract. (Example; scratched or dented doors, dented wood, chipped paint, torn or worn flooring, aged siding or shingles,
existing leaks or cracks, out of plumb or square conditions).
(9) There must be a clear an unobstructed pathway to the site. The customer is responsible for removing any obstructions. This
includes, but not limited to obstructions caused by weather such as ice and snow. We are not responsible for any damage to trees,
lawns, landscaping, or concrete.
We recommend a certified industrial hygienist, or microbiologist perform clearance testing. We are not responsible and will be
held harmless for any past, present, or future microbial growth. We can clean or remove microbial growth at an additional cost.
All estimates are all inclusive. No one line item can be removed of changed without the possibility of a cost increase in other
areas. The line item detail may or may not explain the exact service. Regardless the estimate is for the net dollar total amount.
Price changed to the net amount or line item can only be given with a written price change order by the contractor and/or your
Project Manager.
These specifications are based on the conditions existing at the time of the initial site investigation. The extent of the damage or
contamination may or may not be fully known. Therefore, these specifications may change as new information is obtained, either
before or during the project. Other damage may exist within the structure. This damage should be addressed as it is found, if
needed repairs may be performed at an additional cost. Workmanship will be conducted in a manner consistent with the degree
of care and technical skill exercised by the professionals currently practicing in this field with similar budgets and time
constraints. Recommendations contained in this estimate represent our professional judgment at the time of the project.
Thank you!
____________________________________
Customer Signature
1
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Insured:DEBORAH & RICHARD MILLERBERND Cell:(651) 308-6871
E-mail:debnrich21987@gmail.comProperty:420 21ST AVE S
SOUTH SAINT PAUL, MN 55075-2119
Home:420 21ST AVE S
SOUTH SAINT PAUL, MN 55075-2119
Claim Rep.:Burkett, Kaitlyn Business:(813) 337-5412
E-mail:kaitlynburkett@westfieldgrp.com
Estimator:David R. Troy Business:(612) 547-6324
E-mail:adjuster@troysinc.comCompany:Cross Country Adjusting
Business:PO Box 519
Pageland, SC 29728
Claim Number:0002624519 Policy Number:250966X Type of Loss:Backup of Sewer or Drain
Date Contacted:1/14/2025 4:26 PM
Date of Loss:1/12/2025 12:00 AM Date Received:1/13/2025 1:00 AM
Date Inspected:1/20/2025 4:30 PM Date Entered:1/14/2025 2:05 PM
Date Est. Completed:2/12/2025 2:30 PM
Price List:MNMN8X_JAN25
Restoration/Service/Remodel
Estimate:DEBORAH_&_RICHARD_
M1
2
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 2
The attached repair estimate has been prepared for you in relation to the claim presented under your insurance policy with us.
The estimate may have been created with the assistance of inspections completed by others, or in collaboration with others,
either in person or virtually. It is important to understand that our delivery of the estimate is not a guarantee of coverage. Our
investigation of the claim loss, including assessing the facts, circumstances, and coverage, will determine the payable amounts
under your policy’s terms and conditions.
This is not an authorization to repair. Authorization to repair and guarantee of payment must come from the owner of the
property. Please know that no adjuster or appraiser has the authority to authorize repair or guarantee payment. Additionally, the
quality of the repair work falls outside the scope of insurer responsibility, and as such the insurer assumes no responsibility for
the quality of repair that might be made.
If you choose to hire a contractor or vendor to make repairs, we encourage you to share this estimate with your repair
professional, prior to the commencement of the repairs. If you or your repair professional identify additional damages or costs
beyond this estimate, please promptly notify us. Your timely communication is both appreciated and necessary. Please
understand, we reserve the right to inspect and verify any supplemental claims to determine coverage applicability. Please do not
destroy or discard any damaged items until we have had the opportunity to inspect them and agree on any supplemental costs
with you. If necessary, please set the damaged property aside for our inspection.
We thank you for allowing us to serve your insurance needs. We understand the importance of maintaining open and
ongoing communication throughout the claim process. Please reach out to us should you have any questions or if there
are developments regarding your claim.
3
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 3
DEBORAH_&_RICHARD_M1
Lower Level
Up
Stairs
Recreation Room
Spare Room
Closet
Bathroom
Laundry Room
3'6' 2"5' 8"25' 2"
25' 10"3' 2"3' 2"3' 3"3' 11"3' 9"3' 1"3' 4"9'
8' 8"3' 5"3' 1"6"2' 6"5' 9"
5' 7"3' 9"3' 7"6' 11"10' 7"2' 10"2' 6"
1' 1"
Recreation Room Height: 8'
805.07 SF Walls
1145.73 SF Walls & Ceiling
37.85 SY Flooring
100.24 LF Ceil. Perimeter
340.67 SF Ceiling
340.67 SF Floor
100.24 LF Floor Perimeter
Missing Wall 2' 10 3/16" X 8'Opens into LAUNDRY_ROOM
DESCRIPTION QUANTITY UNIT PRICE TAX O&P RCV DEPREC.ACV
PREPARATION
1. Contents - move out then reset - Large 1.00 EA 133.83 0.00 26.76 160.59 (0.00)160.59
room
2. Mask and prep for paint - plastic, paper,100.24 LF 1.93 2.20 39.14 234.80 (0.00)234.80
tape (per LF)
WALL REPAIR
3. 1/2" - drywall per LF - up to 2' tall 13.00 LF 14.26 1.79 37.44 224.61 (7.48)217.13
4. Seal the surface area w/PVA primer -26.00 SF 0.84 0.13 4.38 26.35 (8.78)17.57
one coat
5. Paint the walls - two coats 805.07 SF 1.38 19.62 226.12 1,356.74 (452.25)904.49
TRIM / DOOR REPAIR
6. Interior door - Detach & reset - slab 3.00 EA 30.87 0.00 18.52 111.13 (0.00)111.13
only
7. Paint door slab only - 1 coat (per side)6.00 EA 35.41 3.25 43.16 258.87 (86.28)172.59
8. Casing - 2 1/4"76.00 LF 2.88 8.89 45.56 273.33 (9.12)264.21
9. Seal (1 coat) & paint (2 coats) casing 76.00 LF 3.15 1.48 48.18 289.06 (96.35)192.71
10. Baseboard - 3 1/4"23.00 LF 4.69 3.61 22.30 133.78 (4.46)129.32
11. Seal (1 coat) & paint (2 coats)23.00 LF 3.12 0.39 14.44 86.59 (28.87)57.72
baseboard
12. Detach & Reset Baseboard - 3 1/4"77.24 LF 3.86 0.13 59.66 357.94 (0.00)357.94
13. Paint baseboard - one coat 100.24 LF 1.39 0.98 28.06 168.37 (56.13)112.24
14. Detach & Reset Base shoe 77.24 LF 2.20 0.13 34.00 204.06 (0.00)204.06
15. Base shoe 23.00 LF 1.99 1.44 9.44 56.65 (1.90)54.75
16. Seal & paint base shoe or quarter 23.00 LF 1.16 0.26 5.40 32.34 (10.78)21.56
round
17. Paint base shoe or quarter round - 1 77.24 LF 0.79 0.69 12.34 74.05 (24.69)49.36
coat
FLOOR REPAIR
18. Underlayment - 1/4" lauan/mahogany 340.67 SF 2.71 27.40 190.12 1,140.74 (38.02)1,102.72
plywood
19. Vinyl plank flooring 340.67 SF 7.22 94.11 510.74 3,064.49 (306.45)2,758.04
20. Floor preparation for resilient flooring 340.67 SF 0.88 2.77 60.52 363.08 (36.32)326.76
CLEANING
4
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 4
CONTINUED - Recreation Room
DESCRIPTION QUANTITY UNIT PRICE RCV DEPREC.ACVTAXO&P
21. Final cleaning - construction -340.67 SF 0.39 0.00 26.58 159.44 (0.00)159.44
Residential
Totals: Recreation Room 169.27 1,462.86 8,777.01 1,167.88 7,609.13
Up
Stairs
Recreation Room
Spare Room
Closet
Bathroom
Laundry Room
8' 5"
8' 11"4' 1"4' 3"3' 9"3' 7"7' 3"6' 11"5' 5"8' 9"8' 7"3'7' 5"7' 9"Laundry Room Height: 8'
356.67 SF Walls
460.25 SF Walls & Ceiling
11.51 SY Flooring
44.58 LF Ceil. Perimeter
103.58 SF Ceiling
103.58 SF Floor
44.58 LF Floor Perimeter
Missing Wall 2' 10 3/16" X 8'Opens into RECREATION_R
Missing Wall 3' X 8'Opens into STAIRS
DESCRIPTION QUANTITY UNIT PRICE TAX O&P RCV DEPREC.ACV
PREPARATION
22. Contents - move out then reset 1.00 EA 89.21 0.00 17.84 107.05 (0.00)107.05
23. Mask wall - plastic, paper, tape (per LF)44.58 LF 1.90 0.98 17.14 102.82 (0.00)102.82
24. Mask and prep for paint - plastic,44.58 LF 1.93 0.98 17.40 104.42 (0.00)104.42
paper, tape (per LF)
WALL REPAIR
25. 1/2" - drywall per LF - up to 2' tall 16.00 LF 14.26 2.20 46.08 276.44 (9.22)267.22
26. Seal the surface area w/PVA primer -32.00 SF 0.84 0.16 5.42 32.46 (10.81)21.65
one coat
27. Paint the walls - two coats 356.67 SF 1.38 8.69 100.18 601.07 (200.37)400.70
TRIM / DOOR REPAIR
28. Casing - 2 1/4"19.00 LF 2.88 2.22 11.38 68.32 (2.27)66.05
29. Seal (1 coat) & paint (2 coats) casing 19.00 LF 3.15 0.37 12.06 72.28 (24.09)48.19
30. Baseboard - 3 1/4"16.00 LF 4.69 2.51 15.50 93.05 (3.10)89.95
31. Seal (1 coat) & paint (2 coats)16.00 LF 3.12 0.27 10.04 60.23 (20.07)40.16
baseboard
32. Detach & Reset Baseboard - 3 1/4"28.58 LF 3.86 0.05 22.08 132.45 (0.00)132.45
33. Paint baseboard - two coats 28.58 LF 2.09 0.42 12.02 72.17 (24.05)48.12
34. Base shoe 16.00 LF 1.99 1.00 6.56 39.40 (1.31)38.09
35. Seal & paint base shoe or quarter 16.00 LF 1.16 0.18 3.76 22.50 (7.51)14.99
round
5
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 5
CONTINUED - Laundry Room
DESCRIPTION QUANTITY UNIT PRICE RCV DEPREC.ACVTAXO&P
36. Detach & Reset Base shoe 28.58 LF 2.20 0.05 12.60 75.53 (0.00)75.53
37. Paint base shoe or quarter round - 1 28.58 LF 0.79 0.26 4.58 27.42 (9.14)18.28
coat
CABINET REPLACEMENT
38. R&R Cabinetry - lower (base) units 2.50 LF 274.36 42.06 145.62 873.58 (83.85)789.73
39. R&R Countertop - flat laid plastic 2.50 LF 56.28 6.17 29.38 176.26 (52.00)124.26
laminate
40. R&R 4" backsplash for flat laid 2.50 LF 11.41 1.16 5.94 35.63 (10.47)25.16
countertop
DETACH/RESET
41. Water heater - Detach & reset 1.00 EA 1,079.12 0.00 215.82 1,294.94 (0.00)1,294.94
CLEANING
42. Final cleaning - construction -103.58 SF 0.39 0.00 8.08 48.48 (0.00)48.48
Residential
Totals: Laundry Room 69.73 719.48 4,316.50 458.26 3,858.24
Up
Stairs
Recreation Room
Spare Room
Closet
Bathroom
Laundry Room
9' 9"
10' 1"5' 9"5' 7"2' 6"2"5' 9"
5' 7"2' 5"2' 1"4' 1"4' 3"Bathroom Height: 8'
238.37 SF Walls
291.70 SF Walls & Ceiling
5.93 SY Flooring
29.80 LF Ceil. Perimeter
53.33 SF Ceiling
53.33 SF Floor
29.80 LF Floor Perimeter
DESCRIPTION QUANTITY UNIT PRICE TAX O&P RCV DEPREC.ACV
43. Casing - 2 1/4"19.00 LF 2.88 2.22 11.38 68.32 (2.27)66.05
44. Seal (1 coat) & paint (2 coats) casing 19.00 LF 3.15 0.37 12.06 72.28 (24.09)48.19
Totals: Bathroom 2.59 23.44 140.60 26.36 114.24
6
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 6
Up
Stairs
Recreation Room
Spare Room
Closet
Bathroom
Laundry Room 3' 4"2' 10"5' 5"3'2' 6"2' 2"1' 3"
1' 1"
Closet Height: 8'
132.00 SF Walls
147.35 SF Walls & Ceiling
1.71 SY Flooring
16.50 LF Ceil. Perimeter
15.35 SF Ceiling
15.35 SF Floor
16.50 LF Floor Perimeter
DESCRIPTION QUANTITY UNIT PRICE TAX O&P RCV DEPREC.ACV
PREPARATION
45. Contents - move out then reset - Small 1.00 EA 66.97 0.00 13.40 80.37 (0.00)80.37
room
46. Mask and prep for paint - plastic,16.50 LF 1.93 0.36 6.46 38.67 (12.90)25.77
paper, tape (per LF)
WALL REPAIR
47. 1/2" - drywall per LF - up to 2' tall 16.50 LF 14.26 2.27 47.52 285.08 (9.50)275.58
48. Seal the surface area w/PVA primer -33.00 SF 0.84 0.16 5.58 33.46 (11.15)22.31
one coat
49. Paint the walls - two coats 132.00 SF 1.38 3.22 37.08 222.46 (74.15)148.31
TRIM / DOOR REPAIR
50. Casing - 2 1/4"16.00 LF 2.88 1.87 9.60 57.55 (1.92)55.63
51. Seal (1 coat) & paint (2 coats) casing 15.00 LF 3.15 0.29 9.52 57.06 (19.03)38.03
FLOOR REPAIR
52. Floor preparation for resilient flooring 15.35 SF 0.88 0.13 2.72 16.36 (1.64)14.72
53. Underlayment - 1/4" lauan/mahogany 15.35 SF 2.71 1.24 8.56 51.40 (1.71)49.69
plywood
54. Vinyl plank flooring 15.35 SF 7.22 4.24 23.00 138.07 (13.80)124.27
CLEANING
55. Final cleaning - construction -15.35 SF 0.39 0.00 1.20 7.19 (0.00)7.19
Residential
Totals: Closet 13.78 164.64 987.67 145.80 841.87
Up
Stairs
Recreation Room
Spare Room
Closet
Bathroom
Laundry Room
9' 2"11' 10"12' 4"9'
8' 8"2' 6"3' 5"3' 1"4"6"5' 9"5' 7"Spare Room Height: 8'
328.00 SF Walls
430.56 SF Walls & Ceiling
11.40 SY Flooring
41.00 LF Ceil. Perimeter
102.56 SF Ceiling
102.56 SF Floor
41.00 LF Floor Perimeter
DESCRIPTION QUANTITY UNIT PRICE TAX O&P RCV DEPREC.ACV
PREP
7
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 7
CONTINUED - Spare Room
DESCRIPTION QUANTITY UNIT PRICE RCV DEPREC.ACVTAXO&P
56. Contents - move out then reset 1.00 EA 89.21 0.00 17.84 107.05 (0.00)107.05
57. Interior door - Detach & reset - slab 2.00 EA 30.87 0.00 12.34 74.08 (0.00)74.08
only
58. Paint door slab only - 1 coat (per side)4.00 EA 35.41 2.16 28.76 172.56 (57.51)115.05
FLOOR REPAIR
59. Floor preparation for resilient flooring 102.56 SF 0.88 0.83 18.22 109.30 (10.93)98.37
60. Underlayment - 1/4" lauan/mahogany 102.56 SF 2.71 8.25 57.24 343.43 (11.43)332.00
plywood
61. Vinyl plank flooring 102.56 SF 7.22 28.33 153.76 922.57 (92.26)830.31
CLEANING
62. Final cleaning - construction -102.56 SF 0.39 0.00 8.00 48.00 (0.00)48.00
Residential
Totals: Spare Room 39.57 296.16 1,776.99 172.13 1,604.86
Total: Lower Level 294.94 2,666.58 15,998.77 1,970.43 14,028.34
Debris Removal
DESCRIPTION QUANTITY UNIT PRICE TAX O&P RCV DEPREC.ACV
63. Haul debris - per pickup truck load -1.00 EA 219.44 0.00 43.88 263.32 (0.00)263.32
including dump fees
Totals: Debris Removal 0.00 43.88 263.32 0.00 263.32
Line Item Totals: DEBORAH_&_RICHARD_M1 294.94 2,710.46 16,262.09 1,970.43 14,291.66
8
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 8
Grand Total Areas:
2,156.44 SF Walls 650.73 SF Ceiling SF Walls and Ceiling2,807.17
680.36 SF Floor 75.60 SY Flooring 260.69 LF Floor Perimeter
0.00 SF Long Wall 0.00 SF Short Wall 255.62 LF Ceil. Perimeter
680.36 Floor Area 713.06 Total Area 1,740.28 Interior Wall Area
906.75 Exterior Wall Area 100.75 Exterior Perimeter of
Walls
0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length
0.00 Total Ridge Length 0.00 Total Hip Length
9
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 9
Summary for Backup Coverage
Line Item Total 13,256.69
Matl Sales Tax Reimb 294.94
Subtotal 13,551.63
Overhead 1,355.23
Profit 1,355.23
Replacement Cost Value $16,262.09
Less Depreciation (1,970.43)
Actual Cash Value $14,291.66
Less Deductible (1,500.00)
Net Claim $12,791.66
Total Recoverable Depreciation 1,970.43
Net Claim if Depreciation is Recovered $14,762.09
David R. Troy
10
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 10
Recap of Taxes, Overhead and Profit
Overhead (10%)Profit (10%)Matl Sales Tax Manuf. Home Tax Clothing Acc Tax Equipment (8.125%)
Reimb (8.125%)(8.125%)(8.125%)
Line Items
1,355.23 1,355.23 294.94 0.00 0.00 0.00
Total
1,355.23 1,355.23 294.94 0.00 0.00 0.00
11
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 11
Recap by Room
Estimate: DEBORAH_&_RICHARD_M1
Area: Lower Level
Recreation Room 7,144.88 53.90%
Laundry Room 3,527.29 26.61%
Bathroom 114.57 0.86%
Closet 809.25 6.10%
Spare Room 1,441.26 10.87%
Area Subtotal: Lower Level 98.34%13,037.25
Debris Removal 219.44 1.66%
Subtotal of Areas 100.00%13,256.69
Total 13,256.69 100.00%
12
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
DEBORAH_&_RICHARD_M1 2/12/2025 Page: 12
Recap by Category with Depreciation
O&P Items RCV Deprec.ACV
CABINETRY 805.41 115.28 690.13
CLEANING 219.25 219.25
CONTENT MANIPULATION 379.22 379.22
GENERAL DEMOLITION 269.17 269.17
DOORS 154.35 154.35
DRYWALL 733.53 21.63 711.90
FLOOR COVERING - VINYL 4,957.26 412.87 4,544.39
FINISH CARPENTRY / TRIMWORK 1,276.20 21.17 1,255.03
PLUMBING 1,079.12 1,079.12
PAINTING 3,383.18 1,034.56 2,348.62
O&P Items Subtotal 13,256.69 1,605.51 11,651.18
Matl Sales Tax Reimb 294.94 36.46 258.48
Overhead 1,355.23 164.23 1,191.00
Profit 1,355.23 164.23 1,191.00
Total 16,262.09 1,970.43 14,291.66
MoistureMapper Project Report
24Restore
Property damage restoration since 1994. 24 Restore provides the people, the equipment, and the expertise to handle any kind ofdisaster situation.
Property Information
Name and Location
Address :420 21st Ave S
City :South St. Paul
State :Minnesota
Zip/Postal Code :55075
Country :United States
Insurance Data
Insurance Adjuster :
Property and Structural Data
Heating Source Type :None
Heating Type :None
Hot Water Heater Type :Electric
Piping Type :None
Roof Style :None
Roof Type: :None
Siding Type :None
Project Narrative
Operational Data
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Date/Time of Loss :1/13/2025 00:00:00
Claim Received by Contractor :1/13/2025 00:00:00
Customer Contacted :1/13/2025 00:00:00
Date/Time Inspected :1/13/2025 00:00:00
Job Start Date/Time :1/13/2025 00:00:00
Job End Date/Time :1/23/2025 00:00:00
Time On Job :10d
Reported Description of Loss
Suspected Cause of the Water Damage
Water Damage - Category 1 - Clear Water
Peril
Water
Loss Report
Damage due to sewage overflow from the city.
Detailed Findings
Areas Affected by the Water Damage :Basement
General Findings :Other
Upon assessment on 1/13/2025, the crew found water damage that appeared to be caused by a sewage overflow from the city affecting
the basement laundry room, utility room, storage room, bathroom and living room. Affected materials include drywall, tile, framing and
concrete. This was a category 3 water loss requiring 10 days for drying.
Final Evaluation and Recommendations
Dried to industry standard.
Technical Project Summary
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13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
Resource Summary
Equipment Summary
Air Mover Used Totals
Equipment Drying
Area Room Equipment
# Jan Days
Air Mover -
Centrifugal Basement basement 11d
Air Mover -
Centrifugal Basement basement 11d
Air Mover -
Centrifugal Basement basement 11d
Air Mover -Centrifugal Basement basement 11d
Air Mover -
Centrifugal Basement basement 11d
Air Mover -
Centrifugal Basement basement 11d
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13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
13 14 15 16 17 18
19 20 21 22 23
Air Mover -
Centrifugal Basement basement 11d
Air Mover -Centrifugal Basement basement 11d
Air Mover -
Centrifugal Basement basement 11d
Air Mover -
Centrifugal Basement basement 11d
Air Mover Subtotal :110d
Refrigerant Dehumidifier Used Totals
Equipment Drying
Area Room Equipment
# Jan Days
Dri-Eaz -Evolution LGR Basement basement 11d
Dri-Eaz -
Evolution LGR Basement basement 11d
Refrigerant Dehumidifier Subtotal :22d
Water Damaged Area(s)
Basement
Room : basement Details
Width 25 ft. 10 in.Total Area /
Volume 665.2 ft.2 / 5321.7 ft.3
Length 25 ft. 9 in.
Height 8 ft. 0 in.Category Water Damage - Category 1 - Clear
Water
Class Factor 3 - Water from above; wet walls; > 24 inches high
(fastest)Flooring Type None
Percent AreaAffected 44 Wall Type Drywall
Linear Wall Affected 45 ft.Insulation Type Fiberglass Batt
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14.0
12.0
S500 Recommendations
Air Movers Number Recommended: 3 to 4 units
Air Movers used:
10 in use
LGR Dehumidifiers AHAM Pints Recommended: 134 AHAM pts.
AHAM Pints Used:
140 AHAM pt.
Desiccant Dehumidifiers CFM Recommended: 267 CFMs
CFM used:
N/A
Air Change Rate Exchange total air volume: Every 20 minutes (3 times an hour).
Psychrometrics continued... (1/13/2025 - 1/22/2025)
Dates 1/13 1/14 1/15 1/16 1/17 1/18 1/19 1/20 1/21 1/22
Outside °F 6 5 26 33 37 -8 2
Outside %RH 66 58 79 77 59 54 48
Outside GPP 5 4.1 15.8 21.2 19.1 1.9 2.9
Inside °F 72 73 74 75 76 77 76
Inside %RH 59 52 46 44 42 26 25
Inside GPP 69.3 63.1 57.7 57 56.3 35.9 33.3
Inside Dew Point °F 57 54 52 52 51 39 38
Grain Dep (In v. Out)-64.4 -59 -41.8 -35.8 -37.2 -33.9 -30.4
Psychrometrics (1/23/2025 - 1/23/2025)
Dates 1/23
Outside °F 6
Outside %RH 56
Outside GPP 4.2
Inside °F 75
Inside %RH 27
Inside GPP 34.8
Inside Dew Point °F 39
Grain Dep (In v. Out)-30.6
Moisture Point Measurements continued... (1/13/2025 - 1/22/2025)
Location Standard 1/13 1/14 1/15 1/16 1/17 1/18 1/19 1/20 1/21 1/22 W/F/C
Point
Location
Height Type Material
basement framing 30.0 30.0 27.0 24.0 23.0 21.0 19.0 19.0 WME%Wood
basement Point 2 100.0 100.0 50.0 20.0 15.0 12.0 WME%
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14.0
12.0
Moisture Point Measurements (1/23/2025 - 1/23/2025)
Location Standard 1/23 W/F/CPointLocation Height Type Material
basement framing 14.0 WME%Wood
basement Point 2 WME%
Dehumidification Output continued... (1/13/2025 - 1/22/2025)
basement : : Dri-Eaz - Evolution LGR 1/13 1/14 1/15 1/16 1/17 1/18 1/19 1/20 1/21 1/22
Output °F 80 86 88 88 86 86 83
Output %RH 26 21 19 19 20 18 19
Output GPP 39.6 38.8 37.4 37.4 37 33.2 31.8
Grain Depression 29.7 24.3 20.3 19.6 19.3 2.6 1.5
basement : : Dri-Eaz - Evolution LGR 1/13 1/14 1/15 1/16 1/17 1/18 1/19 1/20 1/21 1/22
Output °F 88
Output %RH 15
Output GPP 29.5
Grain Depression 3.8
Dehumidification Output (1/23/2025 - 1/23/2025)
basement : : Dri-Eaz - Evolution LGR 1/23
Output °F
Output %RH
Output GPP
Grain Depression
basement : : Dri-Eaz - Evolution LGR 1/23
Output °F
Output %RH
Output GPP
Grain Depression
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Basement CommentsDried to industry standard.ExTech and TrimX
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6
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 6 -1/23/2025
Lower Level/Recreation Room -
11-Overview
Date Taken:1/20/2025
Taken By:D. Troy
Lower Level/Recreation Room -
12-Undamaged Water Line
Date Taken:1/20/2025
Taken By:D. Troy
7
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 7 -1/23/2025
Lower Level/Recreation Room -
13-Damaged Lower Cabinet
Date Taken:1/20/2025
Taken By:D. Troy
Stored in Recreation Room from
Laundry Room
Lower Level/Recreation Room -
14-Damaged Lower Cabinet
Date Taken:1/20/2025
Taken By:D. Troy
Stored in Recreation Room from
Laundry Room
10
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 10 -1/23/2025
Lower Level/Recreation Room -
19-Baseboard
Date Taken:1/20/2025
Taken By:D. Troy
Lower Level/Recreation Room -
20-Baseboard
Date Taken:1/20/2025
Taken By:D. Troy
11
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 11 -1/23/2025
Lower Level/Recreation Room -
21-Baseboard
Date Taken:1/20/2025
Taken By:D. Troy
Lower Level/Recreation Room -
22-Baseboard
Date Taken:1/20/2025
Taken By:D. Troy
14
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 14 -1/23/2025
Lower Level/Recreation Room -
27-2' Flood Cut
Date Taken:1/20/2025
Taken By:D. Troy
Removed during mitigation
16
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 16 -1/23/2025
Lower Level/Recreation Room -
29-2' Flood Cut
Date Taken:1/20/2025
Taken By:D. Troy
Removed during mitigation
29
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 29 -1/23/2025
Lower Level/Laundry Room - 49-
Overview
Date Taken:1/20/2025
Taken By:D. Troy
Lower Level/Laundry Room - 50-
Overview
Date Taken:1/20/2025
Taken By:D. Troy
39
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 39 -1/23/2025
Lower Level/Laundry Room - 62-
2' Flood Cut
Date Taken:1/20/2025
Taken By:D. Troy
Removed during mitigation
50
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 50 -1/23/2025
Lower Level/Bathroom - 78-
Door Casing Removed
Date Taken:1/20/2025
Taken By:D. Troy
Lower Level/Bathroom - 79-
Door Casing Removed
Date Taken:1/20/2025
Taken By:D. Troy
51
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 51 -1/23/2025
Lower Level/Bathroom - 80-
Door Casing Removed
Date Taken:1/20/2025
Taken By:D. Troy
Lower Level/Closet - 81-
Overview
Date Taken:1/20/2025
Taken By:D. Troy
52
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 52 -1/23/2025
Lower Level/Closet - 82-2'
Flood Cut
Date Taken:1/20/2025
Taken By:D. Troy
Removed during mitigation
4
Photo Sheet Insured:DEBORAH & RICHARD MILLERBERND
Claim #:0002624519
Policy #:250966X
Westfield Insurance Group
Westfield Insurance
One Park Circle
PO Box 5005
Westfield Center, OH 44251
1-800-243-0210
Photo Sheet - 4 -1/23/2025
Lower Level/Recreation Room -
7-Overview
Date Taken:1/20/2025
Taken By:D. Troy
Lower Level/Recreation Room -
8-Overview
Date Taken:1/20/2025
Taken By:D. Troy