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Untitled (2) RECEIVED I�AR 2 0 2014 NOTICE OF CLAIM FORM to the City of Saint Paul, Mir��t�LERK 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 municipality 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 additionai sheets. Please note that you will not be contacted by telep6one to clarify answers,so pmvide 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 prceess 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 sometl�ing dces 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 r / � I,, -,, First Name�� Middle Initial � Last Name liLl r�S 0��.�Jl' Company or Business Name Are You an Insurance Company? Yes/� If Yes,Claim Number? Street Address l� 3 � �C-1,�� City �'f i �Q u I State 1 V� � �/ Zip Code�� Daytime Phone(��-11�Cell Phone( ) - Evening Telephone(��- � �a Date of Accidend Injury or Date Discovered �^' �� Time � �� /pm 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. �P C� Q ✓' 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 0 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 you need to include copies of all apulicable 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. 0 Property damage claims to a vehicle:two estimates for the repairs to your vehicle if the damage exceeds $500.00;or the actual bills andlor receipts for the repairs � Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt � 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 � Injury claims: medical bills,receipts � 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—please complete this section Were there witnesses to the incident? Yes No � Unknown (circle) Provide their names,addresses and telephone numbers: /�,r, `1'�, 5� 1.�a5 S Were the police or law enforcement called? Yes No Unknown (circle) If yes,what department or agency? Case#or report# n/ Where did the accident or injury take place? Provide street address,cross street,intersection,narq�f park or facility, closest landmark,etc. Please be as detailed as possible. If necessary,attach a diagram. /�� Please indicate the amou�t you are seeking in compen tion or what you wo ld like the City to do to resolve this daim to your satisfacrion. �� `��-- �_�' !—�C t � �� Vehicle Claims— lease com lete this section check box if this section does not a 1 Your Vehicle: Year�Make Model a.�+►-/' License Plate Number C�� q Z 3 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 Iniurv Claims—qlease complete this section �Ycheck box if this section does not apvlv 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 � -, . f��-�►`��' y �7-c�r.�3 By signing this form, you are stating that all in�'ormation you have provided is true and correct to the best o f your knowledge. Unsigned forms will not be processed. Submitting a false claim can result in prosecution. Date form was completed � ""1��" � � Print the Name of the Person who Completed this Form: � ►'�° (- vt ri 5��` � Signature of Person Making the Claim: Revised February 2011 March 18, 2014 I'm submitting a claim for the amount of$275 (ticket and tow) because I feel my vehicle was wrongfully towed from Herschel Street,just north of the corner of Dayton Avenue and Herschel Street. Parking is extremely limited since the parking ban on the even side of Dayton Ave. It's common to have to park a block or two away from home if you arrive in the evening. Herschel becomes a narrow one-way street south of the corner of Dayton and Herschel, and so it is understandable that there is a parking ban on both sides of the street. However, north of the corner, Herschel Street is a two-way and is much wider.This is where my car was towed. For about 10 days after the parking ban began, there were no parking signs on both sides of Herschel, north of Dayton. Then after about 10 days, I noticed that the no parking signs were gone on the right hand side of Herschel, when facing north from the corner of Dayton. I figured the city took down the no-parking signs on one side of Herschel after neighbors complained about the lack of parking and how it didn't m ke sense to have both sides of the wide two-way street off-limits to park, especially since you an park on one side of all the other two-way streets of the same width in the area.The sig s were gone for at least two weeks, and the street was consistently full of parked cars on the one side. Then suddenly on the morning of Saturday March 15th, my car was gone. I thought it was stolen, but the police said it had been towed. When I picked up my car at the impound lot, they workers there said there had been several people who complained of the same thing, and were going to dispute the ticket and tow. Immediately after I learned it was towed, I took pictures of the block,to clearly show that there were no parking signs on one side of the street but not on the other side where it was towed, and that there were many cars parked on that side because it seemed logical that it was legal to park on that side. I feel the City of Saint Paul's employees are responsible because they should have easily noticed that there were no "no-parking" signs on the side of the block where they issued the ticket, at the time they issued it and designated it to be towed. Especially with all the cars there,they should have seen that there weren't any "no-parking" signs anywhere on that side of the block. I also blame the City Employees for designating both sides of the two-way on Herschel to be "no-parking" when parking is so scarce, and�he two-way street is clearly wide enough to have emergency vehicles pass through even if cars are parked on one side. For these reasons, I'm submitting a claim for the reimbursement of the ticket and tow, $275. Thank you, Eric Christopher, 1735 Dayton Avenue 1�.., �i� �� `' � ; '�� u �" a � � `� �� Fe � � �� State of Minnesota � c�so�,#: IIII�1� ;� �; �?` 620 �� ` £� 9002 il��lll 3143 ��A�� 4 �� ,,,�,N�: 620900231434 _'-� .��t �nsar c�_of ` Identification: ❑DL = ❑DVS Web ❑Photo iD • DL Number ❑FP ❑Other � ❑CQL �State ( Wertle: Fasi Middle Last Sut�a � Addriess-Street,Apt# _ City ! State �P DOB(mMd�/yy) Height yy. ht � � � E� Ger�er O � ❑Juven�e ourt Paient a Guardian's Narne: (� � � OfFense. Cirde One: ❑Same Child's Q - � JPO,DEL q�; �� O Veh Lic.No. Plate Year State ��"k � � � ; � > : ; Make Style ❑16+pass. � Golor �� ` =� . . w { Date of Turie of Oifense . ' `' � "' II � � ;_:.� : _ o�,�r .� ..,, � � -' � n�. ❑U� -_ �rt��9�9 li/e or ❑f a l a l ❑P e d e s tr i a n � Weaiher: . � ❑Commera.al�Jehi�e � BPP�ance required ff checked DOT� #Pourds ov�; �Driver ❑p� � �� DO Ofierse La;aAon � �� p�d ❑gooked " � Grde One;Ciy/CountylTa�mship/Other , .�_ m ,Offense � 4 . �' ` Change DesaiP�+ 3tatute/E?fi'iinanee ❑3rd PM,M # � �� ., .;, -.�., c 4. .• vio(ation GPA ��P� Statute/Ordinance ❑3rd PM,N! ' �� violation GM Change DesaiP�t Statute/Ordinance ❑3rd PM,.M Ofiense violation GM' Charge Desaiption Stahite/Ordinance ❑3rd PM,M ❑SPeed Minn_Stat§169.14(subd._j m� �d0� GM Z°ne PM,M ❑3rd in 12 menths ❑No proof of I urance Minn.Sfat.§169J91(subd._� � M,CaNt < � ❑No Seat BeR Use Minn.Siat§169.686.1(a) € � pN i AC Taken-AC: Test Type: ❑Refused �g�� g� (]Urine � If this is a payable citation,you must pay the amount owed or schedule an appearance within 30 days from the date the ciiation was issued. See the back of this citation for more information. officer(s)Name(s) Officer No(s) a-t � Prosea�tor � Controlling A9erx,Y(CAG) How Issued � MN06209QQ Date Issued O In Person ❑ Mailed �'Left at 5cene A9encY Nart�e: ' ' ' CNlICR Version:2013.1 .d r�ivs`:�;i�� - - � . � � � / t '�.; � � �: � t r r, ?r� ..y'J �� L��; ; :. . . . '� . � . � iy�� 1 • �� f . . 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'��..�T' `�, ` — .�.___ •i � � + . � � �I - _ _ �. . s S *' �i� .1r•9 '. •4� . �' . � •��1� Y��' .,x 1 s� *�n �� ,�. � ��, .� Yr �� wtk�'I�.�r '�� . r� � . � ° 4 E � +� ,ii `�Rp , r; � .ti�r�p t . � � � � � � � n .�-� � -�-, � c� , � ��" � � �, � � � � � � � �- O,� � ? - � �� p:��*' ' � ` ,I-;,.�r; ��. :.i*: , f►s�r �� , , � .t'�� i. c � ' . � i1 <+ 'x.�� ; �.t�: Z ' �� — _=C ''i'�;��,��J �� ! �:,• �p� ti'� �� Y�/,:�, � , , :.c `` ' 'L"� ;. � . : .� � ;'' ; . , . - ` A . • �� {,� '�� . � � �; , i • Y S � � Q; � � � � � � � � � � � � � �r � --� � � v; , � � � � � � � � � � � 1 1 r ` ��r� i j r ��_— ___— -- �;;,�� __ �� _ * , x ; � ___ _ AY a�E � =k T0 A . _� N �. �.� :s.� .�,;Y � .� .� ,r�� 1730 W .� . , _ �'; _ .. �, ��-�~� � . _� C I � u - . � J � HEL N�� _ �� Zoo HE __ - _ _ . _ -„ . ' *. . — ��_ l � :��= ..-a.,rt � "` ' _le �r'+ � ��:.+�i - _ . _.. j �.3= ..� ..� td ..a,-.._. -. _ � .. .. •� -�`�^ ,..� »et':;y:�*` ,,. - "� , �,c` n,a,,�� .-- ��; � ..-w �, _ _ � Lot 830 Barge Channel Road, Vehicle Release Form �mpound , inro�nv�O� ' 83��ARG��NHNNEL RZqSd Invoice#: 29644 SAINZ PA��,66�56a2 CN: 14040882 65�� License#: 973CAY 0�1°400d8g��63$�1QQa5 4/15/2014 14:05 Tow Charge: $ 123.95 Mzrchanti �.�� lz,'m tU' �ay e Storage Charge: $ 1 Admin Charge: $ 80.00 xxxxxxxxYxxx12g5 Entrv Methoa', S�iped - --- I��S� � 219,54 Tax: (7.625%) $ 15.55 �ota�� 4�,04�,4� $ 219.50 5�1q ppp��o�e�,03495� overede oe any other p orblemsbhat Subtotal: Q3i1 1amag 0.00 In�a�,p00006 is vehicle was in the custody of the Service Charge: $ �pprvd'��nl��'e �t. I acknowledge I will report 2�g.50 �ustoae� `°P� �blems to the Impound Lot staff Total Charges: $ `NANK�OU! �� ,he 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 �2000 5 -� Signature