Jones, Taffala DEC/16/2013/MQN 08:37 AM FAX No, P, 002
NOTICE O� C�.A�M FO�M to t�e City of S�int Paul, Minnesota
Minnesota Sterte Slari+re 466.05 srai�s rhttt"...every person...who clnilns cfamages fir�m any municipalrt_y._.shall cause to be presented to the
gpv�rning I>Ody uf t12e mttnlcip0llty wlthin ISD tl[�VS after the alleged loss or injury is discovered a nntice statirtg the tifne,pinct,end
circumstanCBS ther6of,lr�td 1hB pmounr of conrpensation or other relief�emanded"
please complete this form in its ehtixety by clearly typing or pz�int�ng youz��rnswer ta eath ques�ion. YF more space is
needed,attaeh additional sheets. Please note ths►t you wiIl not be contacted by telep�oae tp�larify answers,so provide as
mueh ftlYot'mafion as neCtsSary tp explain�otu�cl�ftn,arAd tlte amount qf compensation being requested. 1''ou will receive a
written acknowledgez►n�e�t once yQUr 1'orm is reeeived. The process can take up to ten weeks ar longer depending on the
nature o�your cla9m. This fot►n must be sig�ned,and 6oth pages completed. Yf something does not app�y,write`N/A'.
S�N� COMP'�.�'x'�D k'4RM ANb UTHE� DOCUIVrENTS T(J: CITY C�ERK,
1�ST T��.Z..4GG� BLVD, 310 CYTX'T�ALL, SA]NT PAT�I,, MN SS�02
First Name f �����-A 'ddle Initial J Last Name J � r' �✓� ���I
�A VED
Company or Susiness Name 3 2014
Are Y'ou an Tnsurance Company? Yes nNJ If Xes,Claim Number?
Street Address Z�Z ��-�. A-�-�,�s ��r-. CITY CLERK
c�ty ��-�-LC� statE ILl l� z�p coa� � 1C�
Daytime Phone����'Ce 1 hone(_) - Evening Telephone(___� -
D�te of Acci�dent/Tnj ury or Date Discover�ed I d � �5-�L0�.3 Time____��__urn/p,r,n
Please szate,in detaii, wh�t occurred(]aappened},and why you are subrn�itrang a clai,nn.Please indicate why or how yoa
feel the Ci of Saint Pt►ul or i em lo ees invo ved a or r s onsible for yaur dAmages.
� � ����i� �e�
Please c��:ck the bax(es)th�t most closely represenf ihe re�ison for completing this form:
❑ My vehicae was damaged in an accident ❑ My vehicle was damaged during a tow
❑ My ve�icle was damSged by a pathole or condilion of the street ❑ My ve�icle was damaged by a plow
� My vehicIe was vvrongfull�epwed and/or ticket � I as inj red c�q Cit roQexCy
�Other rype of property damage--please specify C ' "
❑ Other type of inj�sr'y-please Specify
Zn oz�der to process your clairn vou need to include conies of all ar�»licable documents.
For the claims types lisced below,�lease be sure to include the documents indiented or it will delay the handling pf
your claim. Documents WrL.L NOT be returned and become the property of the City. You are enconr�ged ro keep a
copy for yourself before submitting your claim form.
C3 property damage ciaims to a vehicle:two estimates for the repairs to your vehicle if the damage exceeds
$500.00:or the actual bills aacUor z�eeeipts for the re�airs
O Tovcrir�g claims: legzbXe copies of any ticket issued flnd a copy of the irnpound lot receipt
O Other pro�erty damage etaims_ two repair estimates if the damage exceeds$5(K?_00;or the actunl bills
ar�d/or receipts for the repairs;detsiiled lisc af damaged icems
O Xnjury cxaanns: me[�ical bills,receipts
� Phptagraphs�re�ways weIcorne to document and support your claim but will not be retumed.
Page X of 2-Please complete and return both pages of Ciairn Fprm
DEC/16/2013/MON 08:38 AM FAX No, P, OC3
T+`�tilure to complete ar�d Xetuzx�both pages wi���esu�t axe delay i�a tlae handling of your claim.
A11 Cllims- lease com lete this sectron
Were there wimesses ta the incident7 "• l�o U'nkn wn (circle
Provide their names,addr�sses and tele�phone numbers: S�� ��l..-{� ���'
Were the police or law enforcement c�iled? Y� Na Uaknowrz (c.ircle)
If yes,what departir�i,ent or agency?.���•_��tL.i_.� _��-iLF Case#or report# l`)—o��O�D"".���
Where did the accident or illjury t�ce place? Provic�e street address,cross street,interseetion, name of p�rk or facility,
closest l�ndmark,etc. Piease be as detailed as�ossible. If necessary,attach a diagram_
��L..E f�+�k�T e4(l�
I'Iease indicate the�►nla n[you uz-e seel:in in rompensaCion or what you would like the City to do to resolve this cf�im
to your sazisfact�on. �L��,2 / ��/�( �'
'Vehicle Claims��i�ease Cornhlete this section ❑ check box if thys sectipn does not a�lv
Y�ur VehzcIe: 'Year Make �pd�_ _ �
�,icense Plate Number SCa[e�Color
�.egistered Owner
Driver of Vehacle �
A.rea Damaged
Ciry'Vehic]e: Year Make Model
�.icense plate N'umber Sz1te Color
Driver of Vehicle(City�mployee's Name}
Area Daxn�tged
Th.�urv Clairns-please caknolete this section ❑check box if this 5ection does not,appiv
Hpw were you m�ured�
What par�(s)of yaur body were injured?
Hr�ve you sought mediea�treatment? Yes No �'Ittl�ning to Seek Treatment(circle)
Wk�en did you receive treatrzient? �(provide date(s))
Name of Medical T'rovider(s)� �
Address � Telephone
D'ad you miss work as a result of your injury? Xes No
When did you miss w4rk? (provide daEe(s)}
Name of your Emp��yer:
F�ddress Tetephone
� CheCk here if'yor�are:�tt�ek�i�ng more pa�es to this claim form. Nu�rnber of additio��t pages�,,,,,.
I'3y sigrirrtg t/:is fo�-m,you are starti�ag thut ul1 rnformalfion ynu have provided is tnce and correct to tl:e bes[
of your knowledge, r/rtsigrted fowms will not be,�rocessed.
Szcbmttting a false craim can result in prosecution. l�atQ�oxan�was com�leted ( -" � �J ���
�'rint the Name of the�'ers4n who Comple ' �ox'�: �����14;i--.� � �a�GS
Signature o�Z'erson Ma[cing the Clai : �
Rcvised Febru:iry 2p1 1
/
Page 1 of 5
Saint Paul Police Department
ORIGINAL OFFENSE / INCIDENT REPORT
ComplaintNumber Reference CN Date and Time of Report
13266391 12/15/2013 14:33:00
Primary offense:
CRIMINAL DAMAGE TO PROPERTY (MISDEMEANOR UNDER $500)
Primary Reporting Officer: L22, Cary W Name of location/business:
Primary squad.� 150 location of incident: 2g2 STALBANS ST N
Secondary reporting officer. ST PAUL, MN 55104
Approver; FICC2d211t1, Mark
��strict:Western Date&time of occurrence: 12/15/2013 13:20:00 to
Site: 12/15/2013 13:30:00
Arrest made:
Secondary offense:
Police Officer Assaulted or Injured: Police ONicer Assisted Suicide:
Crime Scene Processed.�Y@S
OFFENSE DETAILS
CRIMINAL DAMAGE TO PROPERTY(MISDEMEANOR UNDER$500)
Attempt Only: Appears to be Gang Related:
Crime Scene Method&Point of Entry
TyPe: Public domain Force used: Hid Inside:
oescriPrion: Highway/street/road/alley Pointofentry:
Method:
NAMES
Suspect
UNKNOWN
Nicknames or Aliases
Nick Name:
Alias:
AKA First Name: AKA Last Name:
Details
Sex: Race: DOB: Resident Status:
Hispanic: Age: from to
Phones
Home: Cell.• Contact:
Work: Fax: Pager:
SP301568F76460F
Page 2 of 5
Saint Paul Police Department
ORIGINAL OFFENSE / INCIDENT REPORT
Complaint Number Reference CN Date and Time of Report
13266391 12/15/2013 14:33:00
Primary offense:
CRIMINAL DAMAGE TO PROPERTY (MISDEMEANOR UNDER $500)
Employment
Occupation: Employer.
Identification
SSN: License or ID#: License State:
Physical Description
US: Metric.�
Height: to Build: Hair Length: Hair Color:
Weight: to Skin: Facial Hair: Hair Type:
Teeth: Eye Color. Blood Type:
Offender Information
Arrested: Pursuit engaged: Violated Restraining Order:
DUI: Resistance encountered.�
Condition:
Taken to health care facility: Medical re/ease obtained.�
Victim Jones, Taffala Jean
282 ST ALBANS ST N
ST PAUL, MN 55104
Nicknames or Aliases
Nick Name:
Alias:
AKA First Name: AKA Last Name:
Details
sex: Female Race: Black Doe: 9/16/1967 Resident Status:
Hispanic: Age: 4g from to
Phones
Home: Ce��: Contact: 651-434-0534
Work.� Fax: Pager.�
Employment
Occupation: Employer:
Identification
SSN.� License or ID#: License State:
SP301568F76460F
Page 3 of 5
Saint Paul Police Department
ORIGINAL OFFENSE / INCIDENT REPORT
Complaint Number Reference CN Date and Time of Report
13266391 12/15/2013 14:33:00
Primary offense:
CRIMINAL DAMAGE TO PROPERTY (MISDEMEANOR UNDER $500)
Physical Description
US: Np Metric: No
Height: to Build: Hair Length: Hair Color:
Weight: to Skin: Facial Hair: Hair Type:
Teeth: Eye Color. Blood Type:
Victim Information
Type: Individual Can Identify Offender: Np Willing to Press Charges: NO
Condition:
Taken to health care facility: Np Medical release obtained: NO
Victim CITY OF ST PAUL
839 DALE ST N
ST PAUL, MN 55104
Nicknames or Aliases
Nick Name:
Alias:
AKA First Name: AKA Last Name:
Details
Sex: Race: DOB: Resident Status:
Hispanic: Age: from to
Phones
Home: Cell.• Contact:
Work: Fax: Pager.
Employment
Occupation: Employer:
Identification
SSN: License or ID#: License State:
Victim Information
rype: Government Can Identify Offender. Np Willing to Press Charges: NO
Condition:
Taken to health care facility.� Np Medical re/ease obtained: NO
SP301568F76460F
Page 4 of 5
' Saint Paul Police Department
ORIGINAL OFFENSE / INCIDENT REPORT
Complaint Number Reference CN Date and Time of Report
13266391 12/15/2013 14:33:00
Primary offense:
CRIMINAL DAMAGE TO PROPERTY (MISDEMEANOR UNDER $500)
SOLVABILITY FACTORS
Suspect can be Identified: n►p BY'
Photos Taken: YeS Stolen Property Traceable:
Evidence Turned In: Property Turned In:
Related Incident:
Lab
Biological Analysis: Fingerprints Taken:
Narcotic Analysis: Items Fingerprinted.�
Lab Comments:
PROPERTY
ITEM#1
��yPe ot�oss: Damaged oate of�oss: 12/15/2013 �ocation�ost: 2g2 st albans south yard
Owner. CITY OF ST PAUL Date Recovered.� Location Recovered:
Model#: Quantity.� Serial#:
Article Type/Item.• Oth2r prOpefty / Miscellaneous items Total value:
oescriprion: city owned light pole knocked over
Turned in at� Locker ID#: Lab exams:
ITEM#2
Type of�oss: Damaged Date of Loss: 12/15/2013 �ocation�ost: 2g2 st albans
Owner. �pnes, Taffala Jean Date Recovered.� Location Recovered.�
Model#: Quantity: Serial#:
,articie rypeiitem: Other property / Miscellaneous items Total value:
oescription: bent fence parts on 4 foot chain link fence where lightpole fell onto.
Turned in at: Locker ID#.• Lab exams:
Participants:
Person Type: Name: Address: Phone:
Suspect
SP301568F76460F
Page 5 of 5
Saint Paul Police Department
ORIGINAL OFFENSE / INCIDENT REPORT
Complaint Number Reference CN Date and Time of Report
13266391 12/15/2013 14:33:00
Primary offense:
CRIMINAL DAMAGE TO PROPERTY (MISDEMEANOR UNDER $500)
Victim Jones, Taffala Jean 282 ST ALBANS ST N
ST PAUL, MN 55104
Victim CITY OF ST PAUL 839 DALE ST N
ST PAUL, MN 55104
NARRATIVE
No ICC
Criminal damage to property report occurred at the corner of St Albans and Iglehart on 12-15-13 at approx.
1330hours.
I sqd 150(Lee) was sent to 667 Iglehart on a caller IDed in the call as Deluca, Karen (507-351-0225 667
Iglehart) who was reporting a street light knocked over. In the call Deluca stated she heard a loud noise and
saw a the light pole knocked over into her neighbors fence. She said when she looked out the window there
was a green SUV type of vehicle passing in the street. Unknown if involved. Deluca was goa at the address and
did not answer her phone.
The light pole was down and across the fence of 282 St. Albans in the back yard. I spoke with the
homeowner/resident IDed as Jones, Taffala Jean (09-16-1967 651 434 0534). She stated she did not see or
hear anything.
There was lots of tire tracks on the road next to the downed pole. In the grass/snow there was tire tracks
approaching the base of where the lightpole would have been attached. It is impossible to determine exactly
how the pole was damaged.
r
List of Photos for CN 13266391:
1. 13266391-12152013_151131-CRIMINALDAMAGE-1.jpg - call screen
2. 13266391-12152013_151144-CRIMINALDAMAGE-2.jpg - damaged pole and area
3. 13266391-12152013_151150-CRIMINALDAMAGE-3.jpg - "
4. 13266391-12152013_151155-CRIMINALDAMAGE-4.jpg - " �
5. 13266391-12152013_151200-CRIMINALDAMAGE-5.jpg - "
6. 13266391-12152013_151203-CRIMINALDAMAGE-6.jpg - ��
7. 13266391-12152013_151208-CRIMINALDAMAGE-7.jpg -
8. 13266391-12152013_151214-CRIMINALDAMAGE-8.jpg -
The labeled photos were TRANSFERRED to the Media Vault.
�
PUBLIC NARRATIVE
Criminal damage to property report occurred at the corner of St Albans and Iglehart on 12-15-13 at approx.
1330hours.
SP301568F76460F
Saint Paul Police Department Pa9e ' °f'
SUPPLEMENTAL OFFENSE / INCIDENT REPORT
Complaint Number Reference CN Date and Time of Report
13266391 12/18/2013 09:23:00
Primary offense:
CRIMINAL DAMAGE TO PROPERTY (MISDEMEANOR UNDER $500)
Primary Reporting Officer.• Gf2y, James R Name of location/business:
Primary squad: �ocation of incident. 2g2 STALBANS ST N
Secondary reporting otficer: ST PAUL, MN 55104
Approver.
�rsrr�ct: Western Date&time of occurrence: 12/15/2013 13:20:00 to
Site: 12/15/2013 13:30:00
Arrest made:
Secondary offense:
t
Police Officer Assaulted or Injured: Police Officer Assisted Suicide:
Crime Scene Processed.�
NARRATIVE
While assigned to this case, I reviewed the original report and learned the Responding Officer spoke with a
`victim of a C.D.T.P. According to the victim, Taffala Jones, an unknown suspect knocked over a city owned M
light pole and damaged her fence at 282 North St. Albans Street.
At this point, a letter was mailed to Jones which stated this incident would be closed because there were no
witnesses, suspects or physical evidence.
Case File Closed - Pended
Property - None Recovered
PUBLIC NARRATIVE
SP301568F76460F
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525 E. Vllaume Ave. / South St. Paul, Minnestoa 55075 Corner Lot f� Section/Quarter
(651)451-2221 - Fax (651)451-6939 '��
Name��-� `? �on2S Dat� 1��.c.- 1 9 20�
Spouse Job No.
Address ZgZ ��• � 1 D4.r�L �'� �O , �J
Salesperson���k v'
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Job Site Address Work Phone� ) Termr ""' — �
50% Start Up Z�p��
Work Phone (Spouse)� ) Balance To Insfaller on
E-mail: CeIlPhone:CoS"/- �/3N-CS3�/ Completion
Customer Initials
QUANTITY �ESCR IPTION k �
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Down Payment: Check $k AmT. Date
Credit Card# Expiration Date
DP� PS� BC� ALL�
A SERVICE CHARGE of 1�/s% per month (18% Annually) will be applied
on all past due balances.
The purchaser shall be responsible for any and all collection and legal costs MATERIAL AND INSTALLATION
incurred by Midwest Fence in the event of this bill becoming past due. TAX
Midwest Fence reserves ihe right to lien the improved property if payment THIS ESTIMATE VALID FOR 30
in full as agreed to in This contract is not received. DAYS FROM ABOVE DATE TOTA 9S`��
Owner responsible for establishing correct property and fence lines.Any Permih required shall be the sole responsibility of the owner.Owner responsible for removol of
obstrudions of every noture which will interfere with the installation of the fence.This contract assumes normal ground conditions.Should rocky or excessive hord digging be
encountered,owner aqrees to pay additionai cosh of such work.Midwest Fence d Mfq.Co.shall furnish only the material and Iabor specified in this contrpct.Any changes made
from the above specifications will be billed at Midwe:t's current retail prices.
This order will become binding only upon Midwetf Fence Manager's appr+�vaL
Customer Signature -�e�� Date
Form 2—Rev.2-05 Manager Salesperson's Signature Date
Copyright0 2005 WWW.midNvestfence.com
i , Midwest Fence reserves the right to uen the improvea properry �T Nay������� DAYS FROM ABOVE DATE
in full as agreed to in this contract is not received. TOTA `"��� 4 "
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� obstrudions of every noture which will interfere with the installation of the fence.7his contract ass�mes normal ground conditions.Should rxky or ezcessive hard digging be
entountered,owner aqrees to pay additio�al tosts of such work.Midwest fence 6 Mfq.Co.shall furnish only the material and labor specified in this contract.Any changes made
f.,....•1.�..1.....�...��t:�..r........�11 6.L,ill.d nf Midwesf's currcnf retail orices.
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ARROW FENCE CO. PRO� SAL
18607 HWY 65 N.E.SUITE B
CEDAR, MN 55011 I�
763-755-0088 FAX: 763-515-4213 '
Proposal Submitted To: TAFFY JONES Date: , 1/1012014
Address: 282 ST. ALBANS Phone: II 51-434-053�1
,
Cit /State2ip: ST. PAUL, MN Fax:
Architect: Fence St le: Date of PI �
,.
; ii
Job Name: Job location: ; �
We hereby propose to tumish material and labor necessary for the completion of: I',
�
,
REPAIR 30' OF 4'CHAIN LINK FENCE AND REHANG GATE SPRING$1000.00 i I '
WINTER FfX$1500.00 � I
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Customer is responsible fcn a1F property lines and permrts. Excesa dirt f►om post holes wdF be le(t at jotr site
otherwise spedfied. 50%down,balance due upon completion,unless prior arrangemerds have been made. � I
In the everrt of unforseen digging condhions extra charges tor tabor and equipment may be applied. I ';
othetwise specified. 50%down,balance due upon completion,unless prior arrangeme�s have been made. '; I I
Arrow Fence co.is not responsible for costs to repair sprinkler lines in conflict wHh the fence instaAation. I I �
We propose hereby to fumish material and labor-complete in aawrdance with above specification,for the su� �:
dollars S
Payment to be made as follows ,
AN material is guaranteed to be as specified. All work to be completed in a substa�al workmanlike manner a ing to
specifications submitted,per standard practices. llny afteration or deviation from above specifications involvin a costs
will be executed oNy upon written orders,and will become an extra charge over and above fhe estimate. AN a�f�meMs
cor�gent upon strikes,acaderits or delays beyond our control. Owner to carry fire,tomado and other necess i
ins�xance. Our workers are fuHy covered by Workers C e "on Insurance. I
Authorized Signature Date�'�� ���!�
Note: This proposal may be withdrawn by us if not accepted within � days. �
ACCEPTANCE OF PROP03AL: The above prices,speafication and conditions are satisfactory� jare hereby
accepted. You are authorized to do the work as speafied. Paymerrt wiN be made as outlined above.
Date of Acceptance ', � '
Signature Signature '
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