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1 Page 1 of 2 Dear Occupant: You contacted the City of Lincoln Park to claim that you discovered that you had suffered property damage or personal injury as a result of a sewage disposal system event. Enclosed, please find the Notice of Claim form and instructions for your use. Public Act 170 of 1964, as amended by Public Act 222 of 2001, requires that if you are seeking compensation for personal injury or property damage, you must show that the sewage disposal system had a defect, that an appropriate government knew, or reasonably should have known, about the defects; that the defect was not remedied by the government agency in a reasonable time; that the property damage or personal injury resulted because of the defect; and that you own and have related the value of the damaged personal property. You are also required to comply with the notice requirements of the Act. Any claim you make must be made in writing within 45 days after the date the damage or physical injury was discovered. The written notice must contain your name, address, telephone number, the address of the affected property, the date of discovery of any property damages or physical injury, and a brief description of the claim. Please use the forms enclosed to report your claim.

2 Receipt acknowledgment: The City of Lincoln Park is in receipt of your claim and has provided you with the following items: 1. Transmittal letter with Notice of Claim form including information regarding Public Act Procedures for cleaning and sterilizing basement after flooding. Homeowner Signature Date Signed This form must be signed and returned with your claim form.

3 Sewer Overflow/Backup Claim Form Completed Form Must Be Returned to: City of Lincoln Park Finance Dept Southfield Rd. Lincoln Park, MI Full legal name(s) of Claimant(s): Full address(es) of Claimant(s): Telephone number(s) of Claimant(s) Full address of affected property: Date of discovery of property damage and/or physical injury: Brief description of claim: Description of property/items damaged, if any, and any physical injuries: Claimant s Signature Date For Internal Use Only: Date received initial notification: 15 Business days from the date of written notification: Date different or additional responsible government agencies notified: 45 days after date received written notification: 45 days after date of discovery stated above:

4 WARNING! DO NOT ENTER flooded basements if electrical systems, such as outlets, appliances or furnace, are flooded. Do not handle any connected electrical cords or appliances until all power has been shut off. Call the electric company for assistance. Even if the electric company has turned off electricity to the area, make certain your house s power supply is disconnected. If you have to step in water to get to the fuse box or circuit breaker, call an electrician first for advice. If you smell gas or suspect a gas leak, leave your home immediately and call the gas company from a neighbor s house. WARNING! Flooded basements can contain sewage or other contaminated materials which are hazardous to health and safety. The following steps will help you minimize these hazards: BASEMENT FLOODING CLEANUP CLEANING YOUR BASEMENT: After the water/sewage has receded, make certain all electrical equipment has been completely disconnected. Flush the floors and walls with water from a hose and then wash the floors and walls with detergent and hot water. Wear plastic disposable gloves and clothing that can be discarded. Then disinfect the floors and flooded portions of the walls using a chlorine bleach solution to a minimum distance of two feet above the flood line. To mix the chlorine solution, use ½ cup of laundry bleach to every 1 gallon of water. During the cleaning and disinfecting (and to assist in drying the basement) ventilate the basement by circulating fresh or outside air using a fan. If at all possible, cleaning, disinfecting and drying should be done within 24 hours of flooding to minimize mold and mildew. Do not track any mud/sewage into the living quarters of your house. Discard any contaminated food items into tightly covered trash receptacles. Food containers such as sacks, cardboard boxes or open containers of any kind should be considered contaminated and discarded. Canned goods in sealed cans may be kept provided the containers are thoroughly washed and scrubbed in hot water and detergent, and then immersed for 1 minute in a warm chlorine bleach solution mixed as described above. Chlorine Bleach is an excellent disinfectant. However, NEVER mix chlorine bleach with ammonia as this combination will produce a poisonous gas!

5 CLEANING YOUR BASEMENT (CONTINUED): Carpeting that has been soaked with water/sewage should be removed and discarded. Clothing, toys, bedding, and furniture can be salvaged if they are carefully properly cleaned and disinfected. Rinse these objects with clean water or use a fine hose spray. Clean off any debris using soft brushes or dab with damp cloths. Air dry objects indoors if possible, as sunlight and heat may dry certain materials too fast causing splits, warpage and buckling. Documents, books, photographs and works of art on paper are extremely fragile when wet. Use caution when handling them. If photographs are wet with mud or sewage, rinse them with clear water but do not touch surfaces. Carefully separate photographs and books and allow them to air dry. Never dry items using a microwave, hair dryer or iron. Some clothes and bedding can be cleaned and disinfected using laundry detergent and bleach, while others may have to be professionally cleaned. Upholstered furniture should be professionally cleaned. Non-porous toys should be thoroughly washed with detergent and wiped down with rubbing alcohol. GAS APPLIANCES: Be sure to check all affected pilot lights or burners on gas appliances. Turn off the gas supply to the main burner and wait 10 minutes. Then light the pilot burner in accordance with the equipment instructions. If the pilot will not light, turn off the gas supply and call the gas company. If gas appliances have been under water, have them inspected and cleaned and the gas control valves replaced by the gas company or a qualified appliance repair person. IF YOUR HOME OR PERSONAL PROPERTY HAS SUFFERED DAMAGE, CALL THE INSURANCE AGENT WHO HANDLES YOUR INSURANCE TO FILE A CLAIM. ELECTRICAL APPLIANCES: If electrical appliances have been under water, have them dried out and reconditioned by qualified service repairmen. Electric circuit breakers and fuses can malfunction when exposed to water, so discard all circuit breakers and fuses that have been submerged. AFTER THE CLEANUP: After cleaning your basement, make sure that your clothing and parts of your body that were in contact with water/sewage are thoroughly washed. Do not permit children to enter the basement until after the floors and walls have been washed, disinfected, and allowed to thoroughly dry. Any mops, brushes, cleaning cloths and clothes used should either be discarded or thoroughly disinfected using the chlorine bleach solution. If you hire cleanup or repair contractors, be sure they are qualified. Be wary of people who drive through neighborhoods offering help. Check references. FOR FURTHER INFORMATION GO TO AND CLICK ON FLOODED BASEMENTS AND GO TO YOU CAN ALSO CONTACT THE WAYNE COUNTY DEPARTMENT OF PUBLIC HEALTH, ENVIRONMENTAL HEALTH DIVISION AT (734) FOR MOLD ISSUES CALL (734) IF YOU WOULD LIKE TO FILE A CLAIM FOR HOME OR PERSONAL PROPERTY DAMAGE WITH THE CITY, YOU MAY OBTAIN A FORM FROM OUR WEB OR PICK ONE UP AT THE CITY HALL, 1355 SOUTHFIELD. YOU CAN ALSO CONTACT THE FEDERAL EMERGENCY MANAGEMENT AUTHORITY (FEMA) TO SEE IF YOU QUALIFY FOR FINANCIAL ASSISTANCE OR A LOAN AT (202) OR GO TO

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