Daggy, Joseph (2) KRUEGER LAW FIRM
Roselawn Village Office Building ATTORNEYS AT LAW
i9i2 Lexington Avenue North,Suite 300
Roseville,Minnesota 55iig John A.Krueger*
Office (65�)628-0800 � s.. John A.Kindseth
Facsimile(651)628-01�� ��.s�"�.��';�:� Jessica A.Servais
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l;'� LU s'� •Also licensed in Wisconsin
September 5,2014 �� � �� �������
City of St. Paul
Attn: City Clerk
I S West Kellogg Blvd.
310 City Hall
St. Paul, MN 55102
RE: Our Client: Joseph Daggy
Your Insured: City of St.Paul
Our File Number: 210824
Date of Accident: 8/11/2014
Dear City Clerk:
Please be advised that we have been retained by Joseph Daggy for personal injuries he sustained as a
result of an automobile collision on August 11, 2014. Our records show that the City of St. Paul has
liability insurance covering this collision. Call us if this is not correct. All future contact and
correspondence should be directed to this office for further handling of this matter.
Please provide us with the following information:
1. The policy limits and coverages for your insured, including any umbrella coverage;
2. A copy of the police report(if available);
3. Any recorded statements taken;
4. Repair estimates; and
5. Color copies of any photographs showing damage to the vehicle(s) involved.
Please note that pursuant to Minn Stat � 72A 201 Subd 11 Disclosure Mandatorv. "An insurer must
disclose the cover�Land limits of an insurance Qolicy within 30 davs after the mformation is requested
in writin�bv a claimant."
If you have any questions or concerns,please call me.
Sincerely,
KRUEG LAW FIRM
n A. K eg r
ttorne t Law
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SEP �9 Z014
NOTICE OF CLAIM FORM to the City of Saint Paul, J����t��K
Minnesota State Statt�te 466.05 states tltat "...every person...who claims dmnages fi�om any�nunicipaliry...shall cause to be presented to tlte
governirtg vocly of the niunicipality within 180 clays afYer the alleged loss or injuiy is discovered a notice stating the time,place,and
circunistances thereof,and t12e amount of cornpensation or other relief dernanded."
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��P'C 1 Middle Initial�Last Name
Company or Business Name
Are You an Insurance Company? Yes/No If Yes,Claim Number?
Street Address ���' 1 Q� `�� 1 ORI\ �:`'��
City � •�C.��� State ��.� � Zip Code '�'�� 1�
Daytime Phone( ) - Cell Phone�)���Evening Telephone( ) -
Date of Accident/Injury or Date Discovered����y Time.�17L7 am/ r�
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 res onsible for your damages.
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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
CI Other type of property damage—ptease specify
❑ Other type of injury—please specify�� � �.c�\,� '�`t�.r�.� � ��� G'�'�� •
In order to process your claim vou need to include copies 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