Fire Damage Settlement
'\
THE CITY OF SALINA, KANSAS
WARRANT CHECK
No. 123888
First National Bank & Trust Co.
Salina. Kansas
6tf2
1 1
........**flU.9DOL_LARS$
$(~~. 'I . ::~::j
...
PAV"-
TO THE
ORDER OF
F'fi:ANC I S GOf'.:REL.l..
III ~ 2 31a8811~ I: ~O ~ ~OO b 2 ~I:
2 ~a ? 2? Sill
INVOICE DATE INVOICE NUMBER INVOICE AMOUNT INVOICE DATE INVOICE NUMBER INVOICE AMOUNT
0/00/00 XXXOOOOO 1 :to 4 ~ 6 f:U. <j) . :;~ ~'i
.
>J1
#
TO WHOM IT MAY CONCERN:
FILE'
'91 OCT 18 PI'I12 LIB
CITY Of SAUNA. Ki
IITY CLERK'S OFFill
T% reptir of th~/ fire dama~ed structure located at ]}L--
Jl ~) St/:/L _____ ~~ under provisions granted by the
the provisions of the Salina City Code.
Building Permit is now complete and the applicant has complied with
1
j'
~
~ldln
City of Salina
P.o. Box 736
Salina, Kansas 67402-0736
n[I'l~rh
J ., L ~; \..,.
9/26/91 ~ECEIPT NO. 42706)
DESCRIPTION
OTHER REIMBURSEMENTS
FIRE LOSS/F.GORRELL/717 N 5TH
AMOUNT
813.20
------------
CHECK NUMBER 0000158206
TOTAL
TENDERED
CHANGE
813.20
813.20
.00
RECEIVED FROM:
MARYSVILLE MUTUAL IN
RECEIVED BY: CC
ORIGiNAL. RECEIPT
.
.
TATES
DJUSTME NT. INC.
714 SOUTH OHIO - SALINA, KANSAS 67402-1573
P.O. BOX 1573 - PHONE (913) 827-1046 FAX (913) 827-7859
MICHAEL L. FECHTER - Branch Claims Manager
..
BRANCH OFFICES:
TOPEKA · KANSAS CITY · WICHITA · JOPLIN · FORT SMITH, AR · TULSA, OK
HOME OFFICE:
PARSONS, KANSAS
August 29, 1991
Jackie Shiver
c/o City Clerk's Office
P.o. Box 736
Salina, KS 67401
Re: Insured - Francis J. Gorrell
Policy - New App
O/L - 7-22-91
Fire
Dear Ms. Shiver:
Please be advised that we represent Marysville Mutual Insurance Co. on the above
captioned fire loss. This fire occurred on the above date and Marysville Mutual
Insurance Co. insures this dwelling located at 717 N. 5th. St. here in Salina.
Total coverage on this house amounts to $10,000 and the total loss after the
deductible and depreciation was taken came to $8,132.00. According to K.S.A.
#40-3901 any fire loss over 75% of the face value of the policy, 10% must be
withheld and a check issued to the city. Per our conversation on August 26,
enclosed is Marysville Mutual's check #158206 in the amount of $813.20 which is
10% of the total loss. Mr. Gorrell's home address is 839 Roach, Salina, KS.
You might also mention to your building inspector that at this time Mr. Gorrell
is in the process of rebuilding this home.
If you have any questions, please let me know.
Very truly yours,
J'/7c-~~--e eX. l~&~<-~
~
Michael L. Fechter
Branch Claims Manager
H F : db
CC: Marysville Mutual Insurance Co.
J'{
=-"
DA"-E
Attached find check in payment of account as listed below-Marysville Mutual Insurance Co.
AMOUNTS
TOTAL
8/23/9i CITY FIRE PROCEEDS FUND 7-11-91 C-17919 40101(
.
F-3960-91 FRANCIS J & ALEXINE B GORRELL
717 N 5th, Salina, Ks
ITEMS
813.20
813.20
AUG 26 199,1
NUMBER OF STORIES
1-1 story
2-2 story
3-3 to 4 stories
EXTENT OF DAMAGE
Confined to the olljecl of origin
Confined :0 part of room Of lIIll8 of origin
Conlined to room of origin
Conlined 10 the lire-raIod 00II1l. of origin
Conlined 10 tIoor of origin
Conlined to lllruclure of origin
EldIlnded beyond lllruclure 01 origin
No damage of tis type (NIA)
lblelermiled Of not
TYPE OF MATERIAl GENERATING MOST SMOKE
IF SMOKE SPREAD
BEYOND ROOM
OF ORIGIN
FORM OF MATERIAl GENERATING MOST SMOKE
,.,..
~
~
· Fill In This Report
In Your Own Words
FOlD
A
B
TYPE OF SITUATION FOUND
11-slructure fire
12-Outside storage/cropland
13-Vehicle fire
14-&ush, grass fire
15-Trash, rubbish fire
16--tlp1osioo-no fire
TYPE OF ACTION TAKEN
l-Extinguishment
z-Rescue
:Hnvestigalion only
FIXED PROPERTY USE (
C
o
E
F
G
H
K
M
N
METHOO OF EXTINGUlSIf.IDfr
1--Sell extinglished
2-Make shift aids
3-PortabIe extinguisher
o
lEVEL OF FIRE ORIGIN
l-Grade level to 9 II.
:!-10 10 19 feet
~ 10 29lee1
P
a
R
S
T roTA!. ACRES
BURNED
U ACRES
GIlASSI.AND
NAME OF
V IW.ROAll
X
KANSAS UNIFORM FIRE INCIDENT REPORTING SYSTEM (K-FIRS)
KANSAS STAT~RE MARSHAL DEPARTMENT
~ ~ LI Fire Department
KANSAS INCIDENT REPORT
DAY
~
KFIRS-l 1/87
(Version 4)
~~
03
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3' C>
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32-Emergency medical call
34-Seard1
3S-Extrication
39--Rescu&-n0t classified
41-spi1l, leak without ignition
43-Excessive heat
44-Power line down
45-Arcing electric equipment
46-Aircralt stand by
47-chemical emergency
49-Hazardous conditions stand by
53-Sm0ke, odor removal
56-Unauthorized buming
61-smoke scare
63-C0ntrolled burning
71-Malicious false
72-Bomb scare
73-System maltunction
7-Ambulance service
ll-F~ in, move up, transfer
MUTUAL AID
l-Received
2-Given
~
;Jl
~
~
f:
~
6
~
l-uR1lAN
[i]
4-AulomIlic exIIngoiIhiIg syslem
5-f'r8.aJnnecl ho8&1ank only
6-f'nH:onnecl ~ draft ~
i
~
G]i
7-Hand-laid iloseA1yO'ant, slarq,ipe
&-Master stream device
4-30 10 49 feet
5-50 10 70 feet
6--Oier 70 feet
w
ESTIMATED TOT A!.
DOLLAR LOSS
.00
7--Qbjeds in flight
&-Below grtlIJld level
4-5 to 6 stories
5-7 to 12 stories
&-13 to 24 stories
Flame-Smoke
1 1
2 2
3 3
4 4
5 5
6 6
7 7
9
o 0
(ComposItion)
~ ~=TYPE
:!-Heavy timber
3-l'rolecled nonoombustIlIe
DETECTOR PERFORMANCE
l-Del in room Of space of fire origin-oper.
:!-Oat. not In rm. Of space of fire origin--qJer.
3-Del1n nn. Of space 01 origin--nol oper.
4-Del not In rm. Of space of origin--nol oper.
5-Del1n nn. or space 01 fire origin
buttnloo SIIlIIlIIo oper.
8-No dM:tn..-.. (NIA)
~ Of not reporled
~~
;~
!i
FlAME
~
4-I.Jnprolected noncornbustille
s-ProIecled ordinary
6-UnproIected ordinary
SPRINKLER PERFORMANCE
1~ operated
~ should have operated-dd not
3-Equipment pre. but fire 100 smaI to oper.
s-No equipment ..-.. (NIA)
o--undef8rnined Of not repoI1ed
~~
1a
~
ill
."
55
m
~
7-25 tl 491lol1es
8--50 stories Of IIIOlll
7-Pro1ect8d wood frame
lHk1poIeded wood frame
SMOKE
~
(Use)
AVENUE OF SMOKE lRAVEL
1-Air hancIing ll.oct 4-SlairweI
2--QJrridor 5-<lpenIng on construdion
shaft . in waI
,
7-1J1i1ily ~ In tIoor
8-No lMIf1U8 01 smofc81raw1 (WA)
SIZE ClASS
ACRES
ACRES
FORESTLAND
SUPPRESSION
COST
=~
!i
-SAlOl
B
TYPE OF SITUATION FOUND
11-Structure fire
12-0utside storage/cropland
13-YehicIe fire
14-llrush, grass fire
l~Trash, rubbish fire
16---Explosioo-o fire
TYPE OF ACTION TAKEN
l-fxtinguishmenl
2-Rescue
3-1nvestigaIion 00y
FIXED PROPERTY
C
D
E
F
G
H
K
l
lot
N
METHOD OF EXTINGU~ENT
l-Sel1 exlInglished
~ shift alds
3--f'orlable 8Xlinglisher
o
p
Q
R
S
T
U
v
X
KANSAS UNIFORM FIRE INCIDENT REPORTING SYSTEM (K-FIRS)
KA~ STATE FIRE MARSHAL DEPARTMENT
I N+:-o Fire Department
KANSAS INCIDENT REPORT
KFIRS-1 1/87
(Version 4)
44-Power line down
45-Arcing electric equipment
4S-Aircra/t stand by
47-Chemicai emergency
49-Hazardous conditions stand by
~moke, ado< removal
~~
5 ~r
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~~
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~~
:g
Ii
I~
~ I
~~
~~
~
~
i
I
32-Emergency medical cail
34--Seardl
3S-Extrication
39-flescu&-nOt classified
41-Spi1l, leak without ignition
43-ExcessMl heat
4-JO to 49 feet
5-50 10 70 feet
6-Ove< 70 feet
4-5 to 6 slorIes
~7 to 12 slorIes
~ 13 10 24 slorIes
FIlme-Smoke
1 1
2 2
3 3
4 4
5 5
6 6
7 7
9
o 0
(~)
~
(Use)
'-~-'i'>,\' ,..............._,
56-Unauthorized burning
61-smoke scare
63-C0ntrolled burning
71-Malicioos faise
72-Bomb scare
73-System malfunction
74-Uninlentional false
_ Other (specify)
WJ
D
8
5:
."
6
m
o
z
~
Z
(')
a
m
z
iil
lEVEl OF ARE ORIGIN
l-Gnlde level 10 9 ft.
2--1010 19 feet
3-20 10 29 feet
NUMBER OF STORIES
1-1 story
2--2 story
3-310 4 slorIes
EXTENT OF DAMAGE
Cormed 10 !he object of orVn
Cormed 10 part of room or _ of orVn
Cormed 10 room of origin
Cormed 10 !he fIr8-nded ~. of origin
Cormed 10 floor of origin
Cormed 10 IIIrucU8 of origin
ExI8nded beyond IIIrucU8 of origin
No cBnage of1lis type (HIA)
lkldelern*l8d or not
TYPE OF MAlERlAI. GENERAllNG MOST SMOKE
F SMOKE SPREAD
BEYOND ROOM
OF ORIGIN
FORM OF loIAlERIAI. GENERAllNG MOST SMOKE
7-Ambulance service
s-Fill in, move up, transfer
[JJ
MUTUAl AID
1-Received
2-Given
IGNITION FACTOR (CauseE'
101.1.
aJann '
IT]
(~)
~
."
~
Cl
:D
~ ~
...
:;;
m
en
.00
4-Automatic extinguishing system
s-Pre-<:onnect Ilosenari< ally
lH're-<:onnect hoseh1ydnVll draft starqipe
7---HanlHaid hoseA1ydnVll, ~
6-Master stream device
7---Dbiects in IIight
&-lleIow ground level
UJ
ESTIMATED TOTAl
DOUAR lOSS
~
~
~
:D
m
...
:;;
m
o
z
!<
~~nwe wrE!~
FlAME DETECTOR PERFORMANCE
WI-Del. In room or space of fir8~,
I, 2--0et not In rm. or space of fir8 origin--qler.
I.( 3-Det.1n rm. or space of origin--i1Ol oper.
4-Oet. not in rm. or space of origin--nol oper.
SMOKE 5-Oet In rm. or space of lire origin
~ but fire 100 smaR 10 oper.
&-No delecm pnIS8l1I (KIA)
D--Undeternbd or not reporled
4-Unprolected noncorrbustible
!;--l'rotected ordInaIy
6-UnprotecIed ordinaIY
SPRINKlER PERFORMANCE
1-Equipment operaled
2-Equipmeot sholil have operated-<lid not
3-Equipment pre. but lire 100 small to oper.
&-No equipment pr-.l (N1A)
G--Uldetermined or not reported
7-Protected wood frame
lI-Unprotected wood frame
~
SIZE ClASS
ACRES
ACRES
FORESTlAND
SUPPRESSKlN
COST
;!;~
~."
~~
~~
- . - -, ----.--,-.--,..~,
PI
'I ..
(
Incident No. 9fO;e1J (
Ci ty
"^'
Exposure No.
Date: 7 / 22/Q,
Rural
Contract
Address of Alann: ~ 7 N. S-fh
Alann Time: 03Lf3 Time Arrived: D?}-f!o
S A L I N A FIR E D E PAR T MEN T
FIRE ALARM REMARK SHEET
Officer U \\J; \~,y
Time In
Service: CSciz3
Time
Truck Out
Property $~)~b, Damage Estimate:
Time
In Equipment
~
Con ten ts $ J J o..<-{) I
No.
Officer . Men
Damage Estimate:
Water Used
~-l~ ~,,<oo~;~SC.BA-J 1-~4X\;J~Y~)
ex.t. CorJJ6.~\~~r 1 rl~~) ~<..o6p ~~))
~or;-. Ye.d;o) p'lk' ~k Li:\\>~.~J S
~- <3cB~ ) 511 s~ ~ L~ "&lNnvJ 4
\-sC.~~ L~ ~~~r-- ~
Metered Yes No ~
E:.J C>3Lf~ C5~7
'f.-d.\
"RS- \
O~'i4 0500
O~l.f4 ~S\.4..
Apparatus/Equipment ~~lfunction or Damage? ~ Fuel Consumption Gal.
(For all major apparatus and equipment malfunctions or damage, attach an additional report.)
Remarks:
~ -ts:~~~~~e, ~ o.l"(~v",1 W4. StAAJI ~~A,vd \vd.\<.... ~u\\'j tr\~~l."\.n~
~Y'''t a,-J ~. ~'6~ a~...fu:.J'\~c a.-t 1\7 "-\' ~ "v\vQ\,,~d. \\k. ~ ~.. \ ~'1
h'~s ~~ ~-\ ~ .-t~~ tx\tl ~ -t~ 4-v.l('.\c.... ~ 1<:;-( oJ E"2.\ -+o~ ~r."" .~s',d~
~ ~\6Q... \~~ W o..b~A 2-3 ~~. ~~k clONr-. i\:.n, C)"\~ -b:li},V' J l~(.
'S:d~~. ~C; -\ ~e.-z..\ ht4J i~vr\Qr \o,oc..k ~O\:I.I~ o..b,~ ~ ~ t\~~ VJc.
('~ ~~Y ~+ 5'~-\-~ c-O ~u~,i) ~vn, \"sf\~ be-\\- d~cl ~ ;~w~sH1~'IaY).
() N:. \0I\'j Wo~:s J' 2.Lf\ ~. \\~ sAiJ ~ ~ 0. ~v:) W\~ ~ \4~ ~
~ ~~ j CJ~ \..~ ~\-~~ v..k +N<j ~t4 Slyt ~ ~~ iY~I\(."'. \r.J~
I.l~~ &\~ *,,4~k... w,rJ<W5 to 4\1It'ISl! ~ o<<,,~~ jI \i..:r. a.rrM~
'"'
~ TIME OUT T!ME rN EQUIPHENT OFFICER tlO. .'~'"
~12D a 34Lf O~7 ~.+: YG{JI'~ ~ ,eL ~ch"~IJj I
~()(p (")Y2.Z) :ST\ ; ~ '\.') C&fl)C. ( 1'1: ~+<., If\.Sp' G 0-\+ L--
~, ~~~,:y~ =: ~ ~~i ::sr~~:t~~:~
~Q. l'\C.LU~ ~ ~ ~ov~~ ~& 11\~ d\~"t ~d~c:.
\n5V(a,,~~ b"~ tr4'lcy br c1"\~ hov~, CQm~.i.