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Baker RECEIVED MAR 2� 2014 NOTICE OF CLAIM FORM to the City of Saint Paul, N�i��►s�E R K 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 municipaliry 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 answer to each question. 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 written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the nature of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102 First Name ✓�S i L Middle Initial�Last Name � �T Company or Business Name Are You an Insurance Company? Yes�o If Yes,Claim Number? Street Address �� a S a a7� S} A�'t- City C�^a�'��a State �N Zip Code $S 9 a 3 Daytime Phone(sO� )9SI _��g Cell Phone(s�� ) `J� - a�s Evening Telephone( ) - Date of Accidend Injury or Date Discovered --3�8�/`f Time 7�Oo �/pm Please state,in detail,what occurred(happened),and why you aze 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. 1�u. A-�'A�-c� Q- tv\a�� 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 ❑ My vehicle was damaged by a pothole or condition of the street ❑ 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—please specify ❑ Other type of injury—please specify In order to process your claim vou need to include conies of all anplicable 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 WILL 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 estimates for the repairs to your vehicle if the damage exceeds $500.00;or the actual bills and/or receipts for the repairs O 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 complete 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—nlease complete this section Were there witnesses to the incident? Yes No rnown (circle) � Provide their names,addresses and telephone numbers: Were the police or 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. Please indicate the am�unt yo�e seeking in compensaaon or what you would like the City to do to resolve this claim to your satisfaction. ��g . , Vehicle Claims—nlease comnlete tlus section �check box if this section does not anplv Your Vehicle: Year 1Vlake Model License Plate Number State Color Registered Owner Driver of Vehicle Area Damaged City Vehicle: Year Make Model License Plate Number State Color Driver of Vehicle(City Employee's Name) Area Damaged In_iurv Claims—please complete this section �check box if this section does not applv 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 miss 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 pages By signing this for►n,you are stating that all information you have provided is true and correct to the best of your knowledge. Unsigned forms will not be processed. Submitting a false claim can result in prosecution. Date form was completed 3/O�v�y Print the Name of the Person who Completed this Form: J�SS�- �� Signature of Person Making the Claim: SS� �j a�( Revised February 2011 .. CI`�ATIOIV � � � � Stabe of Minnesota cimdon#: . I. � �� , � " �� C209��3-1781 , s2o9oo23��8� . co�,ri►�: s�y�cimno�_o�_ �� Identlflcedon:• ❑DL DVS Web ❑Pho6o ID ❑Fp ❑pU�er DL Number MN p.CDL ❑Sfabe . Name: Ftrat Middle last Sufioc �, Address—Street,Apt# Ciiy � �p � DOB(mmlddlYY) Heght Wei9ht � EYes Gender N . , 0 . ❑JuwdN Court PareM a Guardlan's Neme: I ❑Seme Chpd's Q Olhnts.CboN Ons: address as Raoa � ,�ro oa naa�: '1weiAe N �7�� P t�� ,v' M S� o�s��. �or W i��:,�e. ��t �;,t� (s. � � o� o� d nc�a�ecra�n '�-� "x ' o i Fam� �„ 'y E ❑u��no�s p�„�,�,w ur.or a►a�eny� ❑com�da�� Nlee�her: 'Caurt appsranp roqulrod ff dNdted DOT# #Pounds ove�wefBht Flezardous NlaOeriel O.Driver O OiMier O Psseerge► ❑Opewle B�P�ted O Booked ��0" Cifde OIIe:d�Cot��rlTt�p/Qther +„i �"". � 'j. '3 9 ��`•SCf�'s pL �.t F :T Ji �s�� ,� ` �� /dv!'.!�'� v�iola�b'on GM M u•� �e Charge Desaiptlon S�Ordk�ance ❑3M PM,M violation GM � Change�esaiptlon StatutelOrdinance 0 3rd PM,M . violation GM . �� P� Statub/Ordinance ❑3rd PM,M vblation GM ❑3peed MMn.smc g tes.la(aund._) mph zone PIYt,M ❑3rd tn 12 months ❑No proof oT Irreuranoe Minn.Slet§1�.791(subd._� M�OM ❑No Seat Belt Uae Minn.3fAt.§189.888.1(a) PM � AC Taken—AC: Te�t Type: {�efus� p Br�1h"O Bbod 0 UrUte If this is a payable citation�you must pay the amount owed or schedule an appearance within 30 days from tl�e date the citatlon was issued. See the back of this citation for more information. O�iCer(s)Na"'e(s) ,� ,;,� „, p�er►Vo(g) �+ Prosecutor ��9��Y(��) How Issued Date Issued MN0620900 ❑In Pe�son ❑ Mailed grteft at scene Age►xY Name: �t"`��.1 CWICR �f� � Yefsion:20f3.1 DEFENDANT . � � � L � � v�i N O � J � � S � � o � � � � � � � � o � � � C � � � � N N Z U fA tA iR t�A fi1 fH fA � � - �p �. W > � $' m � A � U ' � . N V � � O • , , U m � � V � c � o c� V � m . N b S v � �! � �a� o Z Q C �� I- � Q F- c� cn H � � � � � > c�o � � . , � V W ai �'C u�i W � � � -p S,0 m N ` J O � ' � °' � � � n' � u�i mmrm $. V }Z. . ?T o S °� � "' ai a � � - � m p mcy -� .� v >- � � � m m � � CO � � O � � o � � � cYiv �. I � p � �' � � > � � � Z t/� O. � � � N � � " m = � � ~ � � m � °'c � I U m -> � � � N ru ° � > m '� �,o � Q' } � O � � O U = r � -� � � o o � � a � O t � � > � $ � o � � >- m ~ � �' �t o ° o. ° � E' = o � . .� � ` � � a � � � � � � � > � m ° m � o � � ,Y � � � � � v .�c a ol V1 � � +-�. C ai m m _ �� . � c�i � o oC a � � � E cn -`°o 0 o a° � in Jesse Baker From: *CI-StPaul_CityClerk <CityClerk@cistpaul.mn.us> Sent: Thursday, March 13, 2014 4:40 PM To: 'Jesse Baker' Subject: RE: Parking Citation Attachments: Claim form 2.11.pdf I'm sorry for the negative experience you had while visiting Saint Paul. There was a large communication effort to get the word out, but unfortunately, the city can't post signs on every street for an emergency declaration such as this. If your sister was not aware of the parking ban she may want to sign up for notifications with the City for future announcements. Here is a link for the City's E-Subscriptions https•//public govdelivery.com/accounts/STPAUL/subscri�er/new? You can file a claim against the city to try to get back the cost of the towing and impoundment. I have attached the claim form. To get the ticket dismissed you will need to appear before a hearing officer. I realize that you may not be able to come back to Saint Paul since you live in Chatfield, but if you can here is the link to the office you would need to visit. http://www.mncourts.�ov/district/2/?pa�e=49 Please let me know if I can be of any other assistance to you. Shari Moore,MMC 'City Clerk iCity Clerk's Office 15 W.Kellogg Blvd.,Room 310;Saint Paul,MN 55102 'P:651-266-8686 ':F:651-266-8574 „ ;..,�,�;shari.moor�ci.stpauLmn.us ��,`. '�� +w w •� • ' � ��"'� ----------___----_� _.. From: Jesse Baker [mailto:,j baker p-h-b.com] Sent: Wednesday, March 12, 2014 3:25 PM To: *CI-StPaul_CityClerk Subject: Parking Citation Hi Sheri, I recently was a visitor to your city and had a rather unpleasant experience. My sister lives in Saint Paul and had been out of town for a while and had let my family and I stay at her place (saved us renting a hotel room). We were staying there because we were going to walk in the Muscular Dystrophy walk the following morning at the Mall of America (3/8/14). There was no parking in her lot, so I not seeing any no parking signs in the street and seeing that others had parked on the street (both sides) went ahead and parked my car there from 8:30 at night until it was towed at midnight. I am sure you can guess my frustration over this. My husband woke up at 6:00 am to get in our car so we could head to the walk when we found our car was missing. We are not from here keep in mind, so I had no idea what to do. So I called the Saint Paul Police department and low and behold my vehicle had been towed. So we were given an address where we could find our vehicle and after finally getting a hold of my sister we finally got there to pick up our 1 vehicle. Where I had to pay$219.50 to get my vehicle out of impound and i found that I still had to pay for a parking citation on top of this. I am sure you get many complaints about the ordinance that I apparently broke, but how is a visitor from out of town (Chatfield, MN) supposed to know that they can't park on the street when there is no signs marking this. I was told that it had been on the news for some time. Let me ask you when you arrive in a place out of town is this the first thing you do, watch the news? It was not snowing so I had no idea about a snow emergency. I feel like I was wrongfully charged for this and would like to know what i have to do to get my money back. I am a reasonable person and would love to talk to someone about this situation (507) 951-0828. No worries I am not going to yell at anyone,just want to know what a person has to do to fight such a huge expense for my family. $219.50+$56 is a lot of money for us. That is a lot of groceries I could buy my children. Thank you for your consideration and time. I look forward to talking or hearing from your office. Jesse Baker z