Dimayuga RECEIVED
�EB 2 5 2�14
NOTIC� OF CLAIM rORM to the City of Saint Paul, M�a�'�e,�.°�ERK
Minitesuln Slute Stcrtute 466.05 states that "...enerv persrnt...who clnin�s dcunages.�'rn�r�nnv municipr�lity...shc�ll cnnse�o be pre.sented to!he
�nrerning hody of�t/re nurnicipa/iry withift I80 drrys n/�ter the n!(eged(oss or injurv is discoverecl a notic•e statirrg the tinte,p/ace,mrd
circrrmstnrues thereof,nnd tlie amnunt of compensntion or nther relief demnnded.°
Please complete this form in its entirety by clearly typing or printing your answer to e�ch c�uestion. If more space is
needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as
much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a
writlen acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the
nature of your daim. This form must be signed,and both pages completed. If something does not apply,write`N/A'.
SEND COMPLETED FORM AND OTHER DOCUM�NTS TO: CITY CLERK,
15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102
. I'n ' �
First Name _�1jL�/� Middle Initial Last Name��m
_:. _.,. _ .:, =.�.�=,,;y,,;.,..�,_�: . � .. :_.:� �,�:�—�.. -��---:_�_-�:� =-�,_ �`.-�' z� _ _M�
, Company or Business Name
--— > ,
Are You an Insurance ComPany? Yes/,� 1f Yes, Claim Number?
Street Address l `7 � J�J� `��
City ��• 1 C(1�, State / ' 1 N Zip Code �Q2
Daytime Phone (�� IT�UCell Phone (��_��Evening Telephone(�)���
Date of Accident/lnjury or Date Discovered Time 1a- am�
Please state, in detail, what occurred (happened),and why you are submitting a claim. Please indicate why or how you
feel the City of Saint Paul or its employees are involved and/or responsible for your damages.
Please check the box(es) that most closely represent the reason for completing this form:
❑ My vehicle was damaged in an accident ❑ My vehicle was damaged during a tow
I�IViy vehicle was damaged by a pothole or condition ofthe street G My vehicle was damaged by a plow -
�My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property
❑ Other type of property damage—p lease speci fy �,�� �(J
• �Other type of injury—please specify� � �r� '�7�._ . (�2.�•ir u''"`�
In order to process your clairri you need to include copies of all applicable documents.
For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of
your claim. Documents WII.L NOT be returned and become the property of the City. You are encouraged to keep a
copy for yourself before submitting your claim form.
O Property damage claims to a vehicle: two estimltes for the repairs to your vehicle if the damage exceeds
$500.00; or the actual bills and/or receipts for the repairs
�Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt
O Other property damage claims: two repair estimates if the damage exceeds $500.00; or the actual bills
and/or receipts for the repairs; detailed list of damaged items
O Injury claims: medical bills,receipts
O Photographs are always welcome to document and support your claim but will not be returned.
Page 1 Of 2—Please compiete and return both pages of Claim Form
Failure to complete and return both pages will result in delay in the handling of your claim.
All Claims–please comnlete this section
Were there witnesses to the incident? Ye;s No Unknown (circle)
Provide their names, addresses and telephone numbers:
Were the police ar law enforcement called? Yes Unknown (circle)
If yes, what department or agency? Case#or report#
Where did the accident or injury take place? Provide street address,cross street, intersection, name of park or facility,
closest landmark, etc. Please be as detailed as possible. If necessary attach a diagram �� (,l .�_
���A.sCarO�'a.�.c��rd� ��a�-s�o-r-� �k�'.�
Please indicate the amount you �re seeking in compensation or what you would like the City to do to resolve this claim
to your satisfaction.
—. .__ — —
.,�;,i=� .,,r_, _ _
�, _,: �.�,; � �_,'�.� ` . �,>. _._ . .._. .,
Vehicle Claims– lease com lete this section ❑ check box if this section does not a I
Your Vehicle: Year�_Make Model � � Q-
License Plate Number�/�t I-�It2i 1� State�l _Color l i _
Registered Owner Mi C' I 2 ����' d2r�iYY�Q-�4'L�CrQ �. �.�1� a-��4.
Driver of Vehicle � ��1'���0.
Area Damaged
City Vehicle: Year Make Model
License Plate Number State Color
Driver of Vehicle (City Employee's Name)
Area Damaged
In jurv Claims–please complete this section �heck box if this section does not apply
How were you injured?
What part(s)of your body were injured?
Have you sought medical treatment? Yes No Planning to Seek Treatment (circle)
When did you receive treatment? (provide date(s))
Name of Medical Provider(s):
Address Telephone
Did you miss work as a result of your injury? Yes No
' -" -When did you rriiss work? - (provide date(s))
_
Name of your Employer:
Address Telephone
�Check here if you are attaching more pages to this claim form. Number of additional pabes � .
By signing tliis form,you are stating tlzat all information you lzave provided is true and correct to tlze best
of yoz�r knowledge. Unsigned forms will not be processed.
Sccbmitting a false claim can result in proseciction. Date form was completed , O�//p�/0���
Print the Name of the Person who Completed this Fo � ' Q..` I C1� ��
c
Signature of Person Making the Claim:
Revised Febru:u-y 201 1
-� .,... ._
Wednesday, February 12, 2014
Michelle Pettit de Dimayuga
199 Duke Street
Saint Paul, MN 55102
651.224.1408
City Clerk
15 W. Kellogg Blvd.
310 City Hall
Saint Paul, MN 55102
Dear City of St. Paul, ---- -- _
This letter appeals citation#0900207265, requesting reimbursement of administrative charges,taxes,
impound and towing fees totaling $275.50 that we incurred on O1/15/2014. This amount took me a
weeks' worth of full-time subbing to earn. It pays for our family's groceries for a week. It can pay for
my son's beloved soccer gear and team fees. It can pay for my 10-year old's ArtStart camp. It is also
enough to make me want to move out of Saint Paul City limits, post this letter to all the social networks
and pitch it to a couple of local TV stations.
At 9AM on Wednesday, January 12, 2014, I was substitute teaching at Adam's Spanish Immersion
School at 615 S. Chatsworth Street. My children also go to the school and that day they were late for
the bus, so they rode with me to work that day. Of course the tiny school parking lot was already full, I
parked where I normally would as a parent coming to conferences, on the street, in I parked my vehicle
975 W. Tuscarora Ave. All in all, our three elementary aged kids in the van had a bickering match to
rival anything on TV nowadays. Once they're in class, they're perfect angels,but to say the least I was
pretty distracted that morning, running late, worried about teaching classes I was already late to and do I
have my purse, my lunch bag,my shoes,the laptop,the teaching bag with sub materials etc. Oh and
then there's the way"Don't shove your sister in the snow bank. Hey wait up for me. Stop at the corner
there's buses and no 4-way stop there!!!" ,
At 12 o'clock noon, I went outside to drive back home over lunch break to get my purse because I had '
forgotten it at home and needed to �ake aa� i�ivali�bli:�d friei;d��mii��t� g�spcl c�air practice righ�a�ter
work and thought to myself"I better have my purse with because you never know what can happen." ,
When I took a couple steps out the front door of the school, "Where's my car? Oh great! Now I can't i
even remember where I parked!" I was certain I'd park there and then I realized there were NO other �
cars on the street either and that maybe my van had been towed. We never have to concern ourselves '
with snow emergency routes because we don't ever park on the street. We live on a corner lot with a 2
car garage and enough space to park 3 cars behind it(e have a TON of shoveling to do though.)
By 12:l OPM another staff person gave up her lunch, drove me to my house, my husband dropped his
work in Northeast Minneapolis and drove straight home to drive back to the impound lot at the
Fairgrounds. I dropped him off and drove praying the whole way for green lights and good drivers so
that I could get back in time to teach my next class (I'm the sub, who subs for me?!) My poor hubby
had to pay all the fines and walk a mile in the cold to where my van was parked.
The infuriating thing to me was that even AFTER the plows had been through, the tow trucks were still
towing cars in the neighborhood. I counted 5 tow trucks going north towards the fair grounds and at
least 7 more on the way back south. It looked like a money-making venture, more than a public safety
issue.
Other staff at school said they'd been ticketed but never towed. Was my van singled out because we
have custom plates? TAHIRIH is the name of our first-born, stillborn daughter Tahirih, whose name
means "The Pure One". Buying that van was a leap of faith for us to say YES, we're going to try again
and eventually have a family big enough to fill this van and still have room to be of service to our
friends and family and offer them rides. Since that day, another staff person showed me how to get
onto the City of St. Paul texting/email notification system, which I did promptly, now that my little one
is in kindergarten full-time and I can work some daytime assignments.
We are long-tertn tax-paying, law-abiding residents of St. Paul, since 1994. One thing that is very
unwelcoming and�or�fusir�g to peop�who traue�, liu�c�wo�l�-i�� p�i1 ; ^a��Ci�g-anc�s�evv------ - _ — -
emergency routes. Why are only NIGHT TIME routes labeled? Why can't daytime routes be posted
also? How does one know which street is safe to park on when St. Paul doesn't have a true north/south
or east/west street layout?
Thank you for your time and consideration in this matter. We want to voice our frustration and
indignation and fight for a more"Friendly St. Paul", a more welcoming place to live and work. We also
want to speak up for the thousands of limited-English speaking immigrants, for the multitudes of people
who are home health aides parking on the street everyday, for the die-hard customers of local St. Paul
businesses that we need a clear signage and safe place to park our vehicles.
Sincerely,
�� , �/
Mic elle Pettit de Dima u a �'.1
Y g
Saint Paul Police Impound Lot, 830 Barge Channel Road, Vehicle Release Form
Make: 01 FORD License#:TAHIRIH CN: 14008439 Invoice#: 25434
Date/Time Released: 01/15/201413:11 Tow Charge: $ 123.95
Released to:TOTO Storage Charge: $ 0.00
Paid by: CREDIT CARD Admin Charge: $ 80.00
Released by: RACHEL Tax: (7.625%) $ 15.55
I,the undersigned,have recovered the vehicle described above. Subtotal: $ 219.50
I will check the vehicle for damage or any other problems that
may have occurred while this vehicle was in the custody of the Service Charge: $ 0.00
Saint Paul Police Department. I acKnowledge I will report
damage and/or any other problems to the Impound Lot staff Total Charges: $ 219.50
on this form prior to leaving the impound lot.
Damage and/or other problem:
Police Report made:Yes_No_IF Yes, CN , If NO, Why?
TO PROTECT YOUR RIGHTS REPORT ANY PROBLEMS/DAMAGE BEFORE LEAVING THE LOT
5/2000
Signature
St. Paul Police Department for
Ramsey District Court
RECEIPT
Date/Time: 01/15/2014 13:11 Invoice #: 25434
Vehicle Plate: TAHIRIH/
Payor: OWNER Location Paid: Impound Snow Lot
Citation: Amount:
0900207265 $ 56.00
Total Amount Paid: $ 56.00
Paid by: CREDIT CARD
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