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Schmidt (2) RECEIVED MAR 3 j 201� CITY CLERK ITI-CARGO & STORAG March 26, 2014 To whom it may concern; I think it is pretty bad to��let a pothole as large as the one on the main drag of 7th street going to the airport get as bad as the one I hit. I know that the roads are bad and this winter has been hard on them, but a street car track sticking up about 8 — 10" above the pothole? This makes for a very bad situation for anyone. I did call this into the city on 3/24/14 and it is still not taken care of. How many more vehicles are going to get damaged or worse yet someone getting injured in an accident will it take before this gets fixed? /�� � . Mark Schmidt CITI-CARGO 8�STORAGE CO., INC.•900 APOLLO ROAD•EAGAN, MN 55121 •www.citi-cargo.com 651-686-7221 •WATS 800-864-3752•FAX 651-686-0455 i MAR/24/2014/MON 10: 16 AM FAX No. R�CE��E� P. 002 MaR 3 i zo�� CITY CLEf� NOTICE OF CLAIM FORM tai the City of Saint PauT, �nnesota Minnesora Srnre Srnrure 466.05 srnre.r rhn� "...every person,..who claims damages from any municfpaliry...shnll cnuse to tit presented ro rhe governing 6ody of the munictpntity within 180 c�Qys nfrer the alleged lots or in�'ury is cliscovered n norice stating the tirne,pince,nnd �ir�umStnnces tl�eteof,and the amount of compensAtion or other relief de.,,a.,ded." Please complete th9S form fn i[s entirety by clearly typing or printang yoar answer to each question. ���oro space is needed,attach additionai sheets. please note that you will not be eontacted D�teYephone to clarifj�answers,so provide as much in�ocmation as neeessary to explain yonr claim,and the amount of compensatfon befng requested. 'Y'ou will recei�ve a written ac�owledgement once your foxrn is received. The process can take up to ten weeks or Ionger depending on the natnre of�our claim. This form must be signed,end both pages completed. If something does not a�ply,write'N/A'. SEND CUMPLET�A F4RM AN� OTHER bOCUMENTS TO: CITY' CLERK, 15 WEST I�EI,Y,OCC BLV�, 310 C�TY HA�,L, SAYN'T pAUL, MN 55102 First Name�L��_ Middle Tnitial� Last Name��{{� f t� T Company or Business Name,� �� I G A l2 � �r��A �� .Are You an Tnsurance Company? Yes/� Yf'Yes,Clairn Number? Street Address,�� A �D�.�� �,d��- - City � j�; R� State�' ,M��L- .S�a'TA- Zip Code ��i'1,�.�j, Daytime�hone (�'j).1a3.� 3q,�Cell Phone(�)„���Evening Telephone(�,)�- t��br7 Date of Accidend Injury or Date Discovered �-��-L� 'Itime ,�,1�am� Please state,in detail,what occurred (happened),and why you az'e submitting a claim. please indicate wh�or how you feel the City of Saint Paul or ats employees are involved and/or respansible for your damages. .�•�' �. h�bT OLE �!U r �' - �'- E t„l, � L, �. ,-� � ,a IG Lod !. pEE f'� �� t�� 1,� i T'� r�l F S�'�F�� G !�Q �TA�I c I� .�'T���/c �u� in'', .�' ���r • � � �u� .�T'�ro��c ��T�1 7I�R�,ST/�eET ��f.�r�� b � . Please,check the box(es)that most closely represenC the reason for comple[ing this form: C] My'�ehicle was daxnaged in an accident D My�ehicle vvas damaged during a tow `�My vehicle was damaged by a pothole or condition di the street �My�ehiele was damaged by a plow r�My vehicle was wrongfully towed and/or ticketed � I was injured on City property ❑ Oth�.r type of pro�erty damage—please specify ❑ Other rype of injury—please specify Tn order to pzocess your claim�u�need to include co ies of all applicabte documents. For the claim,s types listed below,please bc suz�e to include the documents indicatcd or it will delay the handling of your claim. Documents WILL NOT be returned and become thc ptoperty of the City. You are encouraged to keep a copy for yourself before submitting�our claim form. '�,Propeny damage elaitns to a vehicle:two estSma�es for the repairs to your vthicle if the damage exceeds $500.00;or the actual bills and/or receipCS for the repairs O Towing claims: legible copies of any ticket issued and a copy of the irzipouz�d lot reeeipt O Other property damage claims:two repau estimates if the damage exceeds$500.00;or the actual bills and/or receipts for t'hc repairs;detailed lisc of darnaged items O �njur.y claims: medical bills,receipts j�Photographs are alwa�s wcicome to docvment and support your claim but wi]l noc be re[urned. Page 1 of 2-Please complete and return both pages of Claim Form MAR/24/2014/MON 10: 16 AM FAX No. P. 003 �ailuxe to complete and return both pages�ill result in delay in the handling of your claitta. All Claims—please eomnlete this section 'Were there witnesses to the incident? Yes No Unknown (cixcle) Provide their names, addresses and telephone numbers: �x�,L��'E MA/Q V E LL E S� " N�1/19� �l�`�"D i���'C�H{I!Q E �U � g�1— ��j-3— IS.�b 0 Were the police or law enforcement called? Yes � Unlcnown (circle) Tf yes,what department or agency? Case#or report# Where did the accident or injury take place? Provide street address,cross street, inCersectiotl, qame of park or facility, cYosest landmark,etc. Please be as detailed as possible. If necessary,attach a diagram. Please indicate the amount you are sceking in compensation or what you would lik.e the City to do to resolve this claim to your saasfaction. Vehicle Claims—please complete this sect�on ❑check box if this secti n d e not a 1 Your Vehicle: Year�_Make,,�-r M L'� Model$�/rY,�qj1l'�_. _ � License Plate Number G�'Tl�1 f�l�� State�Colo: �!��ER Registered Owner� I"f'1 ��A i?r �aR Sx.�,Q,.,Q P� L' D�iver of Vehicle Area Damaged �, Drer/�� S t n� "("11?�.�G K.�nJ'N � ��-� City Vehicle: Year Make Model �,icense plate Number State Color Dxivez o�Vehicle(City Employee's NamC) Area bamaged Iniurv Claims please complete this sectton 0 check box if this seccion does noc anply How Were�ou injured? 'VVhat part(s)of your body were injured? Have you soughc medical treatment? Xe; No Planning to Seek Treatment(circle) When did you receive ueatment? (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 dace(s)) Name of your Employer: Address 7'elephone �Check k�exe I�f you are attaching more pages to this claim form. Number of additional pages By signtng this form,yor�are stating thaf all z»formation you have provided is true and correct to the best of your knowledge. Unsigned far�ns wilC not be processed. Submitting a false claim can result�re prosecution. Date form was completed Princ the 1Vame of the person who Compieted th�s Form: � Signature of�erson Makir►g the Claim:`��'� tl sd r ��.' -- Rcvised Pebruary 201 I MAR/24/2�14/MON 10: 16 AM FAX No. P. 001 � piTY op FACSIMILE TR.ANSMYSSYON' �� �d � �, COVER SHEET Q b � a OU11�IIYII �b � ttal 1 il I Aa � City Council Officcs ,a�. 15 Kcllogg Boulevard West Suite 310 Ciry�Ta1UCourthouse Saint Paul, MN 55102 Phone: 651-266-8560 Fax: 651-266-8574 TO, MUr Ic Sch►�-�� �� FItOM: ��+��c �,s.� FAX #: bSl— b33 � q73c� RE: C1a�m �rm I)ATE: �10TE: Facsimile operator, please deli'ver this transmission to the abo�ve addressee. If yon did not receive all of the pages in good condition, please � ad�vise �z, (651) 266-8560, at your earliest convenience. }��,� ,-e. F�s.� N'UMBER OF PAGES (Y1�TCLU'riYN�G� THYS 1'AG�): 3 � � Bobby & Steve's Auto World "The Best Auto Wor1d/n the World" 1 i�vo'iCe Bill To mark schmidt Plate 9776MY 10250 birkshire rd Descriptio� 2010 USA Make Gmc Savana G1500 Engine N/A Odometer 101,939 Mobile (952) 893-0300 VIN 1GDUHEB49Ai104890 Phone (651) 260-4985 PO # N/A . Work Order # 0000368772 Invoice Date Mar 24 2014 Invoice# 0000365764 Appointment Mar 22 2014 10:22 pm Svc Advisor Coleman, Erik J Promised Mar 23 2014 12:22 am Technician Loomis, Spencer Inspections Performed Courtesy Inspection fiat tire - also check front tire Services Performed Towing $95.00 Towing Charge TOWING $95.00 $95.00 Z Sub $95.00 Install New Tires 4 Mount tire, install new valve stem where applicable, clean and seal tire to wheel seat, set tire pressure to proper inflation. Computer spin balance tire and tivheel. Mount and torque wheel lug nuts to manufacturers torque specifications. 106137625 - 275/45r20 Goodyear Eagle il 4.00 Units $192.56 / Unit $770.24 ZT Mount& Balance 4 Tires $80.00 E* Repair Bent Wheels ( 2 ) R/side 2.00 Units $300.00 Z Please Note Some wheels require lug nut re-torque. Ask your Service Consultant for details. Keeping your tires properiy inflated and rotated will assist in maximizing tire wear life and vehicle handling. Sub $1,150.24 Invoice Totals Total Labor $80.00 Total Parts $1,165.24 Total Before Taxes & Miscellaneous Charges $1,245.24 (*) Shop Supplies $8.00 (E) Environmental Charge 2 % $1.60 (Z) State Sales Tax 7.275 % $84.77 (T) Tire Disposal Charge $2.99 Each $11.96 Totals $1,351.57 Invoice Comments I guarantee that the payment is good and will be good at the time Bobby and Steve's World deposits it. If for any reason it does not clear my bank, I hereby willingly give to Bobby and Steve's a security interest in my vehicle and authorize repossesion of my vehicle. I further understand that all costs, as welf as towing &storage wiil be my responsibility. A one year or 12,000 mile warranty on new parts and labor. No warranty when installing customer parts or USED parts. Warranty work has to be performed in our shop. Customer Signature: schmidt, mark paid $1,351,57 by Visa/Master Card. 7920 France Ave S,Bloomington Mn 55435 � Phone: (9 5 21831-88 3 3 Fax: (952)831-1824 Email:service.bloom@bsaw.com a. � � pU10 dORll! ytiN'�y,�� Fk�qryCE`a��t.NUE S .. �'IN �:;4:5 g�001lNGiDP. �95't b5�-��'3 nt h�nt 1D� 2y3111qNt 12�� lt�: 5b99 Sale �ZSP XX�xI',XXkX thod2iSv�iaed , 0b09 Entrv 1�e �atch�, �0 paarvd; Online ly.,,0.1a ' i14 3�8�Q p3�24 f lnv�•� Q�368i�2 �PPr Code•, � 1,351.51 Total� �V�IY �UP\21 �,U°'� Nh VOU r�KPV15111Nu y .s .<-± -R ' �, � . ` .y . , ;� '._ ' � � � �� � �� �' '� � ,;,: ;s�;, � � ! � .. .. . . , . ' r '' �> . � � . . . . �Po. _ . , - ,�.,, 1.� . . .. p � ��� � �. .� � . � . . ,^ , . T .� .r�. � ,' � . "i . �,. ' . .. . � �� . �' � �_-. "�'�L�. �v:. .a q.. '.s... . . . . � � � . . . � . ,. � •���,. ' .. � .. . . . ' � ' . ... C� . . ... » • ,.. R ' ` . � . �. .. .. .. � � P, . . . 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