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Yang, Suncheng RECEIVED APR 0 2 2014 NOTICE OF CLAIM FORM to the City of Saint Paul, Mir��'�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 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 appiy,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 JU�C�I� Middle Initial Last Name TQ�I Company or Business Name Are You an Insurance Company? Yes N If Yes,Claim Number? Street Address U I � /tt(A�� ' City �� i State � Zip Code SS�D Daytime Phone ( Cell Phone(�)�-�2 Evening Telephon - Date of Accidentl Injury or Date Discovered DZ�� Time /• � 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 aze involved and/or responsible for your damages. o !/�CfS i d r�itc- �L.GC�lI G � Please check the box(es)that most closely represent the reason for completing this form: �1 Iy 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 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 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—please complete this section Were there witnesses to the incident? Yes No Unknown (circle) Provide their names, addresses and telephone numbers: a�4 ��L° �_ C1��tJ 24(0 - Il�i I � �P.� Ja 1.er- Were the police or law enforcement called? Yes No 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. �.. I O i ,.l /�, � ��i✓�'J/o vv��vr��P � c�i�r� Please indicate the amount you are seeking in compensation or what you would like the City to do to resolve this claim to our satisfaction. ��' m�� Vehicle Claims— lease co lete this section check box if this section does not a 1 Your Vehicle: Year Make Model �' License Plate Number State VI Color r Registered Owner �U(1 1'l� a(lP/1 Driver of Vehicle �,�j,Q,��j �,P1Y' v Area Damaged r r City Vehicle: Year�Make Model � License Plate Number 1 C State Color � �� Driver of Vehicle(City Employee's Name) � Area Damaged Iniurv 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 fonn,you are stating that all information you have provided is true and correct to the best of your knowledge. Unsigned for�ns will not be processed. Sub�nitling a false claim can result in prosecution. Date form was completed �J�ZSI��} Print the Name of the Person who Completed this Form: �U N C�11�N� �1�� SignaturC of Person Making the Claim: Revised February 201 I l�farch 25�'. 2014 ' To whom it may concern, On Februarv 1'7`'', 2014. mv vehicle was involved in an accident with a Saint Paul Police squae car. The vehicle has sustained damaees on the left rear end. I have obtained two estimaies as stated with the claim form provided.�The attached supplements are from the police report, case number 14-038678. To compensate for the damages, I would prefer the City of Saint Paul to reach a settlement to have the damages on the vehicie repaire� Plea.se let me know if you have any additional questions. Thank you. Sincerelv. Suncheng Y ana� 878 Aurora Avenue �aint Paul, MN 55104 (651}239-8980 Sunchengyang09@gmait.com tit;uiuctt�ncYvi� -- ��. : �: __ a LaCALWENO �� ti ��'� � A 14031678 N "�;� � . j ��' o �'� � �, wr.woxuh n.rnro ��a �uea xumn twi �wm o.n vEw �'IOII �wwatu� N N 02 b0 '00 Y 2 17 2014 2121 � nwh:rshu n«rrErueFna+srnEC.w..�c nwawrowecriou � o 1� Minnehaha s W �A�" g�� g��— �� w�� munrr�a .rt n eu �m�rorrt aane sra recvr¢�.et�'r.mar uwr.de rr.�tt� � . 62 �,:p St Paul +_• 10 Weide ,�:�. � �� :,::s..K:�,;,��,'.,;�-- �::. -� ,x ra .>+.c?r:.�.�. � � � �...� .+.:. � . ,n....,,. ,.:, . ._....;a : > . y�7pp� MYf10N� OR�RLCB1tENU�lFA.t 6f�TF. C14LE� 0.i��TUi POBRION ORIVENL1CfHtENUilR.7 fTA7E OAIi Ol8T��1�t i�(.C�M�11 � O1 K381144641512 MN D O1 O1 P006189656606 Mi�1 Q �1 111 flGTptl f4WEliflff.Y00LEWf1 MIEOFMM WWEIMtT.YCOL[.IMTI d,Tf0�W1f� IN:IONt JEFFREY LAWERENCE CRAGG 09 11 75 CHEW CHI LOR 05 17 93 MMNFN MO�IEli 'JRNOL R TIIiCI �DOMN . WIUUI 11Ef11YLf YlRNER O1 367 GROVE N. O1 , 681 LEXINGTON PKWY N N O1 O1 PNY1f1 GiY.LTATE 2� t CITY,S7A1'L'!r' �� O1 ST PAUL 55101 f. ST PAUL 55104 651-276-0110 pl p�pN�� 5 SEY SI�FEC-0Pf YfEfpPf MIW6 FJ�T YUfI�' 'T ii FFIf EOPT LKEEWf ulWO EIECT MYlEV . 11CONN0 Q1 �.T M "�4 "" 04 06 OS N s•�" M �4 "'�04 06 OS N O1 � .aaa ttve oauo nv¢ ro�nsr Twws�ani irwu.v+ce semrrE aw�uueFa Kea mme mw �nr •o wv m.KVO�r ..uu..rE�oive[ aw�w�cn `�` 98 �t�s� 98 N: p�. •"l�• 98 �" 98 N a�. ., .. ....__, ..: .�,_ ...�. ......:... .. .... . ... :..... ,.•... ...... . . ,._,_ .., , _... . aa. �.� � . a,.�� .� ,. , «�,. 02 CITY OF ST PAUL N . SUNCHENG YANG N 03 �7vo �oonEx ra�n �od�cu N° �iTTP O1 367 GROVE ST N.� 878 AURORA AVE vEMUBf U1v.6GTEii pAiING OAKT CT'.iTRE.2F NWIO D+Rf.I KMU� p� ST PAUL, .MN 55101 `30' 03 ST PAUL, MN 55104 "!� 03 O1 on.x w�[ uooK �rE.w eaa� u�u�[ .�ma .w caw¢ wo�oe 06 FORD CROW 200 BLA HOND ACCO 99 GRE 06 pqSEV KATEY tTM� YfMME�I �L�/ClOf�! �OfT�WUEN+R.PUIE/ 7TREG YF.NREG rr� i�[MCiOF� u0f�ww O�]N . �2 POLICE O1 �� O1 ` 734KVJ MN 013 t:` . ra�cnu�¢R. wswr�nc[N�A mi,nwwEq . �:':CITY OF ST PAUL - GEICO 9316583999 �i Cjq00••'HKYU MMNFO NYE�TION/ Ni/MDOE• VMIV� w�tW{T �DY '. r� .� IFACCIDENT INVOLVEDACONMEiiCULNOTOR VEHICIE,SCHOOI BW,OR HEAO START BUS .a.c rna � . RE6(EMBER TO NOTIfY TNE 8TA7E PATROL(raqulnd und�r M81i9.70.1�nd 169A311). CON�EMqNLVEnQEMtMEIIi-MORIRCMMERIMIE OOTNILBER fl\YEIM9YVEMf1ENlfiHi].YOTORGRNIEANME OOfM�lA1 VAalFN�M1NtfMEpE� uNT 1N MlfOilR K% T'?C IqE NOA6 F�ECt WJlEV IOrKWP TRANYMf ` �� M07EIlVICi AIMMkYEII . TIM FILIOWICH OL �3 M 04 04 �6 05 N N Dor�� O�V MNlEANCE � IRIIIIIIAW G � M71IKW LINDSEY LaR (651-2�6-1191) 02 03 B/16/ F'' QQ QQ 06 D�J N N �pmu � �� ili M 04 04 06 05 N N �"" �� l� YEE VA LOR (651-246-1191) 02 �6 0�� . ....... .. . ..... . ........ _ . . . ...�.--- GW�DPMO�F�iV„711DN'TkMU,.91 �! � ONMER OF OTEII ON1MiED 1110PFAT'Ni01]6tGlIItON O�ow�GED MOPETi'/ANDNiI YEtLOW tli6 MYld1@1 � '"__........ ... ...... ... .......... ....�..�..�.�.�..... .�.:� .,.., w:cm , .ww�rnE: °� ,. O l ', 98 F"""1°` `�,� Vehicle 12 slowed quickly due to traffic abruptl " Y`4 03 I ;?� slowinq when an unknown vehicle made a sudden . w� �'" �:;s.turn from E/B Minnehaha. to N/B Weide. Vehicle �1 ; 98 O1 �`'? came up from behind and tried to avoid Vehicle c„er„ooc ..` ( .'. f2, buE couldn't stop in time. Vehicle {1 struck +�'�� ' wEwE ` Vehicle #2 in the left rear.Np injuries to any � N ' O :� occupants of either vehicle. Photos of both 02 rnc o�wc��:: � ',�;,ir' � 98 ( ': vehicles were•taken on the scene. I �`��_ �',Nsarwn, I I �2 I °AE'�"� NOT TO SC.ALE �1�' I I - � 04 i rroESaq LIGI7 . O 8 MNNEMAHA M WIS � �� .� � � O Q Q 3 : � � p�� Y o�+orw� w�oaw O 1 I �2 ` ,„ ,�(�. �qp�r PA'"°f��"��M: �iTAffMTROI LOP11 a;rtaw�.cr�wcwoe.00e� �� $t Paul pD �/� Q weien Q orwn �� Sergeant Mike Ernster 123 �/ yi i t�� https://dvslesupport.org/dvsinfo/accidentrecords_2008/Includes_LE/PrintReportIndiv_LE.... 2/18/2014 Page � of 6 Saint Paul Police Department ORIGINAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 21:48:00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR Primary Reporting O�cer.� Cf299, Jeffrey Name of location/business: Primarysquad: 373 Locationofincident: MINNEHAHAAV E &WEIDE Secondaryreportingo�cer.• FIIIOwICh, Timothy ST PAUL, MN 55106 aPpro�er.� Ernster, Michael ��sr�ct: Eastern Date&time of occurrence: 02/17/2014 21:21:00 to Site: 02/17/2014 21:49:00 Arrest made: Secondary offense: Pofice Officer Assaulted or Injured: Police O�cer Assisted Suicide: Crime Scene Processed:YeS OFFENSE DETAILS TRAFFIC ACCIDENT-SQUAD CAR Attempt Only: Appears to be Gang Related: NAMES Driver Lor, Chew Chi 681 LEXINGTON AV W ST PAUL, MN 55104 Nicknames or Aliases Nick Name: Alias: AKA First Name: AKA Last Name: Defails �i r� � Sex: Male Race: Asian DOe� 5/17/1993 Resident Status: i Hispanic: Age: 2Q from to � Phones I Home: Cel►:651-276-0110 Contact: ; Work: Fax: Pager.� Employment � Occupation: Employer.• SP301568F76460F . Saint Paul Police Department Page 2 o,s ORIGINAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 21:48:00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR Identi�cafion SSN: License or/D#: P006184656606 License State: MN Other City Of St. Paul ST PAUL, MN Nicknames or Aliases Nick Name: Alias: AKA First Name: AKA Last Name: Details Sex: Race: DOB: Resident Stafus: Hispanic: Age: from to Phones Home: Cell: Contact: Work: Fax: Pager. Employment Occupation: CITY OF ST PAUL Emp/oyer.� Identification SSN: License or ID#: License State: Other Lor, Maikon Lindsey 1304 REANEY AV E ST PAUL, MN 55106 ' Nicknames or Aliases � Nick Name: Alias: AKA First Name: AKA Last Name: !I Details i, sex: Female Race: ASI2tl DOB: Resident Status: � Hispanic: Age: from to �I SP301568F76460F I I Page 3 of 6 Saint Paul Police Department ORIGINAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 21 :48:00 � Primary oNense: TRAFFIC ACCIDENT-SQUAD CAR Phones Home: Cell:651-246-1191 Contact: Work: Fax: Pager. Employment Occupation: Employer: Identification _ SSN: License orlD#: L842125619214 license State: MN Other Lor, Yee Va 681 LEXINGTON AV W I ST PAU L, M N 55104 Nicknames or Aliases Nick Name: Alias: AKA First Name: AKA Last Name: Defails sex: Male Race: Asian DOe: g/1/2000 Residenr Starus: Hispanic: Age: �3 from to ' Phones I Home: Cell:651-276-0110 Contact: Work: Fax.• Pager. , Employment I! Occupation: Employer. �, I Identification SSN: License or ID#: License State: Suspect I I UNKNOWN Nicknames or Aliases ; Nick Name: i Alias: � AKA First Name: AKA Last Name: I, SP301568F76460F Page 4 of 6 Saint Paul Police Department ORIGINAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 21 :48:00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR Details Sex: Race: DOB: Resident Status: Hispanic: Age: from to Phones Home: Cell: Contact: Work: Fax: Pager.� Employment �-�'' Occupation: Empioyer: 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 Informafion Arrested: Pursuit engaged: Violated Restraining Order. DUI: Resistance encountered: Condition: Taken to health care facility: Medical release obtained: SOLVABILITY FACTORS Suspect can be Identified: 61'� Photos Taken: YeS Stolen Property Traceable: Evidence Tumed In: Property Tumed In: ; Related lncident: � Lab �I Biological Analysis: Fingerprints Taken: Narcotic Analysis: Items Fingerprinted: Lab Comments: SP301568F76460F Page 5 of 6 Saint Paul Police Department ORIGINAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 21:48:00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR VEHICLE INFORMATION (Information Only) Registered owner. LOP, Chew Chi Status Description Status: Other License no.: 734�/� Year.� �ggg Towed: State: MN ryPe� Sedan owner.� Lor, Chew Chi Year.• 2/2014 coior. Green Sto�en Method: V.I.N.: 1 HGCG5642XA068242 Doors: 4 Lock status Make: Honda Transmission: AutOmatiC Keys in vehicle: YeS Model; ACCORD Shift Position: COIUPT111 Mileage: Vehicle Damage LEFT DARER SIDE REAR , Registered owner.� City Of St. PBUI Status Description .... Status: License no.: Year. Towed: State: MN Type: Owner. City Of St. Paul Year. Color. Stolen Method: V.I.N.: Doors: Lock status Make: Transmission: Keys in vehicle: Model: Shift Position: Mileage: Vehicle Damage FRONT LEFT SIDE. Participants: Person Type: Name: Address: Phone: Driver Lor, Chew Chi 681 LEXINGTON AV W ST PAUL, MN 55104 Other City Of St. Paul ST PAUL, MN Other Lor, Maikon Lindsey 1304 REANEY AV E ST PAUL, MN 55106 Other Lor, Yee Va 681 LEXINGTON AV W ST PAUL, MN 55104 SP301568F76460F r:�_ Saint Paul Police Department Page 6 of6 ORIGINAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 21:48:00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR Suspect NARRATIVE ICC Squad#1088 Available. On, 02/17/2014 at 2121 hours Squad #373, Officers (Cragg&Filiowich) were en-route to EOT when we were ' involved in a minor Squad Accident. � While en-route to EOT I was driving (Squad #1088) east bound on Minnehaha Ave St. Paul MN, 55106 at approximately 29 MPH when the vehicle (Green 199 Honda Accord MN LIC:plate 734KVJ) directly in front of ine ;%::-came to a sudden and complete stop at Minnehaha and Weide Street. I could see the two other unidentified vehicles in the distance that also slam on there breaks. One vehicle quickly turned north bound on Weide (no signal) and the other continued east bound. It should be noted I was unable to identify either vehicle I saw in the distance. As I approached the vehicle I pressed my right foot on the break attempting to stop but instead the Squad car locked up and began to slide on the icy road. At this point I attempted to a void hitting the vehicle in front of ine by pulling the steering wheel to the left. As the squad car was sliding it clipped the left rear end of the vehicle in front of ine causing minor damage. Our squad car also only had minor right front damage. I quickly exited my squad car to make sure the vehicle I rear ended and its passengers were ok. I spoke with the driver identified as LOR, CHEW CHI (05/07/1993 681 Lexington Ave St. Paul MN, 55104 C/P:651-276-0110) who was a valid MN driver and declined medical attention. Also in the vehicle was LOR, MAIKON, LINDSEY (1304 Reaney St. Paul MN, 55106 C/P:651-246-1191 Front Passenger) and LOR, YEE VA (08/01/2000 681 Lexington Ave St. Paul MN, 55104 C/P:651-276-0110 Back rear passenger) both declined medical attention. -,;Myself and Officer Filiowich both declined medical attention. Squad #379 (Officer Maloney) arrived and took pictures, see his supplement report. Squad #309 (Sgt. Ernster) was notified of this incident, see his stated accident report. PUBLIC NARRATIVE Minor Squad Accident, no injuries. ` SP301568F76460F Page 1 of 1 Saint Paul Police Department SUPPLEMENTAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/18/2014 13:05:00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR Primary Reporting Officer.� C2fIS0�, Steven L Name of location/business: Primarysquad.� Locationofincident: MINNEHAHA AV E &WEIDE Secondaryreportingofficer. ST PAUL, MN 55106 Approver.� oisrrict: Eastern Date&time of occurrence: 02/17/2014 21:21:00 to Site: 02/17/2014 21:49:00 Arrest made: Secondary offense: Police O�cer Assaulted or Injured: Police O�cer Assisted Suicide: Crime Scene Processed: NARRATIVE � On 02-18-14, I, Sergeant Carlson reviewed this case. This was a traffic accident involving marked squad #1088. No Tags were issued at the scene. -Noted. PUBLIC NARRATIVE SP301568F76460F Page � of 2 Saint Paul Police Department SUPPLEMENTAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 23:31 :00 ;Primary offense: TRAFFIC ACCIDENT-SQUAD CAR Primary Reporting O�cer.� M81011@y, Sean M IVame of location/business: Primarysquad: 360 �ocation ofincident: MINNEHAHA AV E &WEIDE Secondary reporting officer.� ST PAUL, MN 55130 Approver.� Sh2111@y, Andrew �istrict. Eastern Date&time of occurrence: 02/17/2014 21:21:00 to Site: 02/17/2014 21:21:00 Arrest made: Secondary offense: TRAFFIC ACCIDENT-PROPERTY DAMAGE ACCIDENT Police Officer Assaulted or Injured: Police O�cer Assisted Suicide: Crime Scene Processed: OFFENSE DETAILS TRAFFIC ACCIDENT-SQUAD CAR Attempt Only: Appears to be Gang Related: TRAFFIC ACCIDENT-PROPERTY DAMAGE ACCIDENT Attempt Only: Appears to be Gang Related: , SOLVABILITY FACTORS Suspect can be Identified: By: Photos Taken: YeS Stolen Property Traceable: Evidence Tumed/n: Property Tumed In: Related/ncident: Lab Biological Analysis: Fingerprints Taken: ~Y Narcotic Anatysis: Items Fingerprinted: Lab Comments: Participants: Person Type: Name: Address: Phone: ' SP301568F76460F Saint Paul Police Department Page 2 °f2 SUPPLEMENTAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 23:31:00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR NARRATIVE No ICC available On 2/17/14 at 2121, I Squad 360 (Maloney) was sent to Minnehaha and Weide to take photos for Sqd 373 (T. Filiowich/ Cragg) on an accident. When I arrived I took the following photos: List of Photos for CN 14031678: 1. 14031678-02172014 225916-TRAFFICACCDNT-1.jpg - Street signs at intersection 2. 14031678-02172014 225940-TRAFFICACCDNT-2.jpg - license plate on vehicle 3. 14031678-02172014 230005-TRAFFICACCDNT-3.jpg - front driver side 4. 14031678-02172014 230019-TRAFFICACCDNT-4.jpg - rear driver side 5. 14031678-02172014 230025-TRAFFICACCDNT-5.jpg - close up of damage 6. 14031678-02172014 230036-TRAFFICACCDNT-6.jpg - rear passenger side ..��:�7. 14031678-02172014 230058-TRAFFICACCDNT-7.jpg - front passenger side ��`J� 8. 14031678-02172014 230131-TRAFFICACCDNT-8.jpg - front of Squad 1088 9. 14031678-02172014 230149-TRAFFICACCDNT-9.jpg - front driver side of Squad 1088 10. 14031678-02172014 230200-TRAFFICACCDNT-10.jpg - front passenger side of Squad 1088 11. 14031678-02172014 230208-TRAFFICACCDNT-11.jpg - close up of damage 12. 14031678-02172014 230215-TRAFFICACCDNT-12.jpg - same 13. 14031678-02172014 230230-TRAFFICACCDNT-13.jpg - rear passenger side 14. 14031678-02172014_230243-TRAFFICACCDNT-14.jpg - rear driver side ' The labeled photos were TRANSFERRED to the Media Vault. ; See ORIGINAL report for further information. ; � PUBLIC NARRATIVE I Photo supplement report ' _ � ( � I SP301568F76460F Pa9e 1 of 2 Saint Paul Police Department SUPPLEMENTAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 23:11 :00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR Primary Reporting O�cer. Eft1St2P, Michael J Name of location/business: Primarysquad: 309 Locationofincident• MINNEHAHAAV E &WEIDE Secondary reportrng officer.� ST PAUL, MN 55106 Approver.• Eft1St@f, Michael oistrict: Eastern Date&time of occurrence: 02/17/2014 21:21:00 to Site: 02/17/2014 23:11:00 Arrest made: :Secondary offense: TRAFFIC ACCIDENT-PROPERTY DAMAGE ACCIDENT Police Officer Assaulted or Injured: Police O�cer Assisted Suicide: Crime Scene Processed: OFFENSE DETAILS TRAFFIC ACCIDENT-SQUAD CAR Aftempt Only: Appears to be Gang Relafed: TRAFFIC ACCIDENT-PROPERTY DAMAGE ACCIDENT Attempt Only: Appears to be Gang Related: SOLVABILITY FACTORS Suspect can be Identified: gy: , Phofos Taken: Stolen Property Traceable: Evidence Turned In: Property Turned In: Related Incident: Lab Biological Analysis: Fingerprints Taken: Narcotic Analysis: /tems Fingerprinted: Lab Comments: �articipants: �erson Type: Name: Address: Phone: I SP301568F76460F Pa9e 2 of 2 Saint Paul Police Department SUPPLEMENTAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 14031678 02/17/2014 23:11 :00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR NARRATIVE Squad 309 (Sgt Ernster) was notified by 373 (Cragg/Filiowich) that they were involved in a squad accident and responded to Weide and Minnehaha where the accident occurred. Upon arrival the occupants of the vehicle that was struck were sitting in their vehicle. I spoke to the driver Chew Chi Lor (05/17/1993) and he stated he was ok. I asked if the other two people in the car if they were ok and Lor answered that they were fine. Lor stated he was driving E/B on Minnehaha when the E/B vehicles in front of him suddenly slowed when a car decided to turn N/B on Weide from Minnehaha. When he�lowed down quick is when he was struck from behind by Officers Cragg and Filiowich. Lor's vehicle (Mn Lic# 734-KVJ) had light to moderate damage to the left rear bumper area. ;, Officer Cragg was driving Squad #1088 E/B Minnehaha approaching Weide when traffic in front of him suddenly slowed. Officer Cragg tried to stop and avoid the accident, but was unable to and struck the left rear of Lor's vehicle. Squad #1088 suffered light to moderate damage to the front right headlight area. Squad 360 (Maloney) responded to the scene and photographed both vehicles involved in the accident. See his supplement for details. State accident report was completed under this case number. PUBLIC NARRATIVE suppJement report SP301568F76460F LATUFF BROS., INC. 880 UNIVERSITY AVENUE ST. PAUL,MINNESOTA 55104 (651)224-2828 FAX: (651)291-0677 FEDERAL�D#41-0777034 ***PRELIMINARY ESTIMATE*** 03/24/2014 08:20 AM Owner Owner: SUNCHENG YANG Address: 878 AURORA AVENUE APT#2 Work/Day: Home/Evening: (651)239-8980 City State Zip: Saint Paul, MN 55104 FAX: Inspection Inspection Date: 03/24/2014 08:18 AM Inspection Type: Inspection Location: Latuff Brothers Inc Contact: Address: 880 University Ave Work/Day: (651)224-2828x FAX: (651)291-0677x City State Zip: Saint Paul, MN 55104 Work/Day: Email: general@latuffbrothers.com • Primary Impact: Left Rear Comer Secondary impact: Appraiser Name: MATTHEW HOWARD Appraiser License#: Repairer Repairer: Latuff Brothers Inc Contact: Address: 880 University Ave Work/Day: (651)224-2828 FAX: (651)291-0677 City State Zip: Saint Paul, MN 55104 Work/Day: Email: general@latuffbrothers.com Vehicle i 1999 Honda Accord LX 4 DR Sedan 4cyl Gasoline 2.3 UCEV � 4 Speed Automatic I Lic Expire: VIN: 1 HGCG5642XA068242 ; Prod Date: 01/1999 Mileage: ' Veh Insp#: Mileage Type: Actual Condition: Code: H1263B Ext.Color. DARK EMERALD PRL Int.Color. Ext. Refinish: Two-Stage Int.Refinish: Two-Stage Ext.Paint Code: G87P,G87P-3 Int.Trim Code: Options AM/FM Stereo Tape Air Conditioning Bucket Seats Center Console Cruise Control Dual Airbags Intermittent Wipers Power Brakes Power poor Locks Power Mirrors Power Steering Power Windows Rear Window Defroster Rem Trunk-L/Gate Release Tachometer Tilt Steering Wheel Tinted Glass Velour/Cloth Seats 03/24l2014 08:23 AM Page 1 of 3 1999 Honda Accord LX 4 DR Sedan Claim#: � 03/24l2014 08:20 AM Damages Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R Rear Bumner 1 UC 566 Cover,Rear Bumper Replace Reconditioned $295.00* 0.9 SM 2 L 566 13 Cover,Rear Bumper Refinish 3.5 RF 2.4 Surface 0.6 Two-stage setup 0.5 Two-stage 3 E 521 N/Plate,RR Bumper Cove 75731S84A00 $11.72 0.2 SM Rear Bodv. Lamos And Floor Pan 4 UC 533 Taillamp Assembly,Otr LT Replace Reconditioned $86.00* 0.3 SM Manual Entries 5 SB Hazardous Waste Removal Sublet Repair $5.00* SM' 6 N Flex Additive Additional Labor $5.00* SM' 6 Items MC Message 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE Estimate Total 8�Entries Gross Parts $11.72 � Other Parts $386.00 Paint Materials $112.00 Parts&Materiai Total $509.72 Tax on Parts&Material @ 7.625% $38.87 Labor Rate Replace Repair Hrs Total Hrs Hrs Sheet Metal(SM) $52.00 1.4 1.4 $72.80 Mech/Elec(ME) $85.00 Frame(FR) $75.00 Refinish(RF) $52.00 3.5 3.5 $182.00 Paint Materials $32.00 Labor Total 4.9 Hours $254.80 ' Subiet Repairs $5.00 � Gross Total $808.39 Net Total $808.39 Alternate Parts No SPPL Yes Zip Code:55104 Default Audatex Estimating 7.0.123 ES 03/24/2014 08:23 AM REL 7.0.123 DT 02101/2014 DB 03/15/2014 Copyright(C)2013 Audatex North America, Inc. 1.1 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. 03/24/2014 08:23 AM Page 2 of 3 1999 Honda Accord LX 4 DR Sedan Claim#: . 03/24/2014 0820 AM THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE PARTS MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MFINUFACTURER OF YOUR VEHICLE. A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS CONIMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. Op Codes * = User-Entered Value E = Replace OEM NG= Replace NAGS EC= Replace Economy OE= Replace PXN OE Srpls UE= Replace OE Surplus ET= Partial Replace Labor EP= Replace PXN EU= Replace Recycled TE = Partial Replace Price PM= Replace PXN Reman/Rebit UM= Replace Reman/Rebuilt L = Refinish PC= Replace PXN Reconditioned UC= Replace Reconditioned TT = Two-Tone SB= Sublet Repair N = Additional Labor BR= Blend Refinish i = Repair IT = Partial Repair CG= Chipguard RI = R&I Assembly P = Check AA= Appearance Allowance RP= Related Prior Damage This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the insured,claimant and others on a need to know basis in order to effectuat�the claims process)without ��r�"t3� Audatex's priorwritten consent. i.. d S�dery�p!�i�d.'t} - - Copyright(C)2013 Audatex North America, Inc. Audatex Estimating is a trademark of Audatex North America, inc. � � 0324l2014 0823 AM Page 3 of 3 RAYMOND AUTO BODY� INC. �Norkfile ID: f152b298 FederalID: 41-0888257 1075 PIERCE BUTLER RTE, SAINT PAUL, MN 55104 Phone: (651) 488-0588 FAX: (651) 488-4794 Preliminary Estimate Customer: YANG, SUNCHENG 7ob Number: Written By: DAMON SLAIKEU Insured: YANG, SUNCHENG Policy#: Claim #: Type of Loss: Date of Loss: Days to Repair: 0 Point of Impact: Owner: Inspection Location: Insurance Company: YANG,SUNCHENG RAYMOND AUTO BODY,INC. 878 AURORA AVENUE 1075 PIERCE BUTLER RTE #2 SAINT PAUL, MN 55104 ST PAUL, MN 55104 Repair Facility (651) 239-8980 Day (651)488-0588 Business VEHICLE Year: 1999 Body Style: 4D SED VIN: 1HGCG5642XA068242 Mileage In: Make: HOND Engine: 4-2.3L-FI License: Mileage Out: Model: ACCORD LX Froduciior� Date: State: Vehicle Out: Color: Int: Condition: Job#: TRANSMISSION DECOR RADIO SEATS Automatic Transmission Dual Mirrors AM Radio Cloth Seats Overdrive Console/Storage FM Radio Bucket Seats POWER CONVENIENCE Stereo WHEELS Power Steering Air Conditioning Search/Seek Wheel Covers Power Brakes Intermittent Wipers Cassette PAINT Power Windows Tilt Wheel SAFETY Clear Coat Paint Power Locks Cruise Control Drivers Side Air Bag OTHER Power Mirrors Rear Defogger Passenger Air Bag Power Trunk/Gate Release ' I � 2/24/2014 3:05:42 PM 019495 Page 1 Preliminary Estimate Customer: YANG, SUNCHENG 7ob Number: Vehicle: 1999 HOND ACCORD LX 4D SED 4-2.3L-FI Line Oper Description Part Number Qty Extended Labor Paint Price$ 1 REAR BODY&FLOOR 2 * Rpr Rear body panel 'i.Q 1.2 3 Add for Clear Coat 0.5 4 R&I Rear panel trim 0.4 5 R&I RT Trunk side trim 0.5 6 R&I LT Trunk side trim 0.5 7 TRUNK LID _ 8 * Rpr Trunk lid � 2.1 9 Overlap Major Non-Adj. Panel -0.2 10 Add for Clear Coat 0.4 11 * R&I Emblem"H"factory installed � 12 Repl Emblem clip 91512SR3004 2 7.00 13 Repl Nameplate"Accord"factory 75722S84A00 1 17.80 0.2 installed 14 Repl Nameplate"LX"factory 75731S84A00 1 11.72 0.2 15 REAR LAMPS 16 R&I RT Lens&housing 0.4 17 R&I LT Lens&housing 0.4 18 R&I RT Lens&housing 0.4 19 Repl LT Lens&housing 33551S84A01 1 100.83 0.4 20 REAR BUMPER Zl 0/H bumper assy 1.6 22 Repl Bumper cover 04715S84A91ZZ 1 346.87 Incl. 3.2 23 Add for Clear Coat 1.3 24 Repl Energy absorber 71570S84A00 1 47.77 Incl. I 25 MISCELLANEOUS OPERATIONS ' 26 * Repl Cover car/bag 1 9� � 27 # Hazardous waste removal 1 6.00 X � 28 # Color tint/color match 1 0.5 � 29 # Rpr Color sand and buff lA I 30 # Repl Flex additive 1 8.00 SUBTOTALS 545.99 10.2 30.2 2/24/2014 3:05:42 PM 019495 Page 2 Preliminary Estimate Customer: YANG, SUNCHENG )ob Number: Vehicle: 1999 HOND ACCORD LX 4D SED 4-2.3L-FI ESTIMATE TOTALS Category Basis Rate Cost$ Parts 539.99 Body Labor 10.2 hrs @ $59.00/hr 601.80 Paint Labor 10.2 hrs @ $59.00/hr 601.80 Paint Supplies 10.2 hrs @ $39.00/hr 397.80 Body Supplies 5.8 hrs @ $8.00/hr 46.40 Miscellaneous 6.00 Subtotal 2,193.79 Sales Tax $984.19 @ 7.6250% 75.04 Grand Total 2,268.83 Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 2,268.83 WHILE WE HAVE MADE EVERY EFFORT TO WRITE A COMPREHENSIVE REPORT OF THE VISIBLE DAMAGE TO YOUR VEHICLE, IT IS IMPORTANT TO REMEMBER THAT THIS IS ONLY AN ESTIMATE. THERE ARE A NUMBER OF FACTORS THAT CAN AFFECT THE ACTUAL COST OF REPAIRS, INCLUDING BUT NOT LIMITED TO HIDDEN DAMAGE, PARTS PRICE CHANGES, AND INSURANCE COMPANY INVOLVEMENT. PLEASE CONSIDER THIS WHEN MAKING DECISIONS REGARDING THE REPAIRS TO YOUR VEHICLE. ,� 2/Z4/2014 3:05:42 PM 019495 Page 3 Preliminary Estimate Customer: YANG, SUNCHENG 7ob Number: Vehicle: 1999 HOND ACCORD LX 4D SED 4-2.3L-FI QUALITY REPLACEMENT PARTS WARRANTY OUR REPAIR ESTIMATE MAY SPECIFY THE USE OF QUALITY REPLACEMENT PARTS. QUALITY REPLACEMENT PARTS ARE PARTS NOT MANUFACTURED BY OR FOR THE ORIGINAL EQUIPMENT MANUFACTURER. WE WILL STAND BEHIND THE QUALITY REPLACEMENT PARTS THAT ARE SPECIFIED ON THIS ESTIMATE AND USED IN THE REPAIR OF YOUR VEHICLE, FOR AS LONG AS YOU OWN/LEASE THE VEHICLE. WE WARRANT THESE PARTS ARE OF LIKE KIND, QUALITY, SAFE�Y, FIT AND PERFORMANCE TO PARTS MANUFACTURED BY OR FOR THE ORIGINAL EQUIPMENT MANUFACTURER. THIS WARRANTY EXCLUSIVELY COVERS LOSS OR DAMAGE THAT IS RELATED TO DEFECTS IN THE QUALITY REPLACEMENT PART. THIS WARRANTY DOES NOT COVER DAMAGE OR PART FAILURE DUE TO IMPROPER INSTALLATION, MISUSE, NEGLECT, ABUSE, IMPROPER MAINTENANCE, ABNORMAL OPERATION, OR NORMAL WEAR &TEAR. SHOULD A SUPPLIER OF A PART SPECIFIED IN OUR REPAIR ESTIMATE, OR THE REPAIR FACILITY THAT PERFORMS THE REPAIR ON YOUR VEHICLE, BE UNABLE TO RESOLVE A LEGITiMATE COMPLAINT ABOUT THE QUALITY REPLACEMENT PART USED IN THE REPAIR, WE WILL MAKE EVERY EFFORT TO SEE THAT THE PROBLEM IS CORRECTED. THIS WARRANTY AND ANY REPRESENTATIONS MADE HEREIN ARE NON-TRANSFERABLE AND EXTEND ONLY TO THE PARTY OWNING/LEASING THE VEHICLE AT THE TIME OF THE REPAIR. FOR ASSISTANCE, PLEASE CONTACT THE NEAREST CLAIM DEPARTMENT OFFICE. DISCLAIMER: ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT INSURANCE CLAIM FOR THE PAYMENT OF A LOSS MAY BE GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. ' THE LABOR AND TAX RATES USED WERE DETERMINED BY THE VEHICLE INSPECTION LOCATION UNLESS THE REPAIR FACILITY WAS KNOWN AT THE TIME OF THE INSPECTION OR ANOTHER LOCATION WAS SPECIFIED BEFORE THE ESTIMATE WAS PREPARED THIS IS NOT AN AUTHORIZATION TO REPAIR. TO ENSURE REPAIRS WILL BE COMPLETED BASED ON THIS ESTIMATE; PLEASE PROVIDE A COPY TO THE REPAIR FACILITY PRIOR TO AUTHORIZING REPAIRS. FAILURE TO DO SO MAY RESULT IN YOU BECOMING RESPONSIBLE FOR PAYING UNAPPROVED EXPENSES. NO PAYMENT FOR A SUPPLEMENT WILL BE APPROVED OR ISSUED UNLESS THE REPAIRS WERE AUTHORIZED PRIOR TO COMPLETING THE SUPPLEMENTAL REPAIRS. TO EXPEDITE THE HANDLING OF ANY SUPPLEMENTAL DAMAGES, PLEASE ACCESS HTTP://WWW.THESHOPOFCHOICE.COM/FARMERS. IF YOU NEED TECHNICAL ASSISTANCE REGISTERING OR UPLOADING A�ACHMENTS, CONTACT NUGEN IT CUSTOMER SUPPORT AT (855)-684-3648 BETWEEN 7 AM AND 7 PM CENTRAL TIME. POTENTIALLY, A REINSPECTION MAY BE NECESSARY. CIRCLE OF DEPENDABILITY SUPPLEMENTS: CIRCLE OF DEPENDABILITY PROGRAM SHOPS WILL CONTINUE TO PROCESS SUPPLEMENTS THROUGH THE NORMAL SUPPLEMENT PROCESS. PLEASE CONTACi"YOUR FIELD OR OFFICE CONSULTANT IF YOU HAVE ANY QUESTIONS. THIS PROCESS DOES NOT APPLY TO BRISTOL WEST. 2/24/2014 3:05:42 PM 019495 Page 4 Preliminary Estimate Customer: YANG, SUNCHENG 7ob Number: Vehicle: 1999 HOND ACCORD LX 4D SED 4-2.3L-FI MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide AEG4422, CCC Data Date 2/14/2014, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicte dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or pouble Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non OEM or A/M. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2014 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be ;icne or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category. X=Miscellaneous Non-Taxed charge category. SYMBOLS FOLLOWING LABOR: D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass fabor category. M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R8cI=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating -A product of CCG Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR=6ureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 2/24/2014 3:05:42 PM 019495 Page 5