Signed Damages to Hwy 13 ROWNOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota
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 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 _Julie_______ Middle Initial _L Last Name __Boehmke______________________________
Company or Business Name
__MnDOT_________________________________________________________________
Are You an Insurance Company? No If Yes, Claim Number? __________________________________
Street Address _____395 John Ireland Blvd___________________________________________________________
City __St. Paul________________________ State __MN___________________ Zip Code _55155_________
Daytime Phone (_651___)_366___-_4820_____ Cell Phone (____)____-______ Evening Telephone (____)____-__
Date of Accident/ Injury or Date Discovered __May 28, 2020______________ Time ___N/A______ am / 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. _See attached letter for
full details.______________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
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
X Other type of property damage – please specify _Breach of water main pipe_______________________
Other type of injury – please specify _Damage to right of way of Trunk Highway 13 In order to process your
claim you 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.
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
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 X No Unknown (circle)
Provide their names, addresses and telephone numbers: 1.) Mary Wenner, MnDOT Mendota Truck Station Supv;
2229 Pilot Knob Rd. Mendota Heights; 651-366-5926 and 2.) John Rivard, MnDOT Drainage Crew Supv; 2485
Hadley Ave. N., Oakdale, MN 55128; 651-775-4384
Were the police or law enforcement called? Yes No Unknown - X (circle)
If yes, what department or agency? __State Patrol on site; unknown whether they were called to the site or stopped at site on own accord. Case # or report # N/A ___ 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. Trunk Highway 13 in Mendota Heights from approximately the Big Rivers Regional Trail Crossing near Second Street to 850 feet north of Second Street. Please see marked area on attached copy of Google Maps screen shot. Please indicate the amount you are seeking in compensation or
what you would like the City to do to resolve this claim to your satisfaction. $12,925.85
______________________________________________________________________________
______________________________________________________________________________________________
Vehicle Claims – please complete this section ________ check box if this section does not apply
Your Vehicle: Year __________ Make _______________ 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______________________________________________________________
Injury Claims – please complete this section ________ X check box if this section does not apply
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______________________
X Check here if you are attaching more pages to this claim form. Number of additional pages _15; Cover letter (2
(2 pages), three work order summaries (5 pages), Google map screen shot (1 page) and 8 pictures.
By signing this form, 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 ___September 4,
2020_____________________
Print the Name of the Person who Completed this Form: __Molly Murphy on behalf of Julie
Boehmke____________________________________________
Signature of Person Making the Claim: _____________________________________________________________
Revised February 2011
X
Office of Chief Counsel
395 John Ireland Boulevard
Mail Stop 130
St. Paul, Minnesota 55155
September 4, 2020
Sandra Bodensteiner
City of Saint Paul Clerk’s Office
310 City Hall
15 West Kellogg Boulevard
Saint Paul, Minnesota 55102 Via email: Sandra.Bodensteiner@ci.stpaul.mn.us
Re: Tort Claim -- Damages to Trunk Highway 13 Right of Way
Dear Ms. Bodensteiner,
Enclosed please find Notice of Claim Form to the City of Saint Paul, Minnesota, which is
submitted on behalf of the Minnesota Department of Transportation (“MnDOT”). Also enclosed are
three work order summaries setting out MnDOT’s direct costs related to the claim, eight photographs
evidencing MnDOT’s damages, and a copy of a Google Maps screen shot showing the location in which
MnDOT’s claim arises. Additional photographs are available upon request.
On or about May 28, 2020, there was a breach of a Saint Paul Regional Water Services
(“SPRWS”) water main pipe located near or on Hunter Court in Mendota Heights. The breach was not a
result of any action or inaction on the part of MnDOT. The breach caused mud, foliage, and other debris
to cascade down the bluff and onto and over MnDOT’s right of way for Trunk Highway 13. Debris filled
and ultimately flowed over MnDOT’s drainage ditch and pipe structure in the right of way. The area of
Trunk Highway 13 that was affected extends from approximately the Big Rivers Regional Trail Crossing
near Second Street to 850 feet north of Second Street in Mendota Heights.
MnDOT was required to close Trunk Highway 13 in the area and to deploy staff and equipment
to clear debris from and make repairs to the right of way. MnDOT staff were further required to
continue to monitor the site to remove additional debris flowing down the bluff. As of June 23, 2020,
MnDOT has incurred costs of $12,925.85, all of which were directly caused by the breach of SPRWS’s
water main. These costs are documented in the enclosed work order summaries.
MnDOT hereby demands payment from the City of Saint Paul in the amount of $12,925.85. The
damage caused by the breached water main pipe may increase MnDOT’s contract costs for ditch and
culvert work scheduled for the area in 2020, in which case, MnDOT may submit an additional Notice of
Claim Form.
Please contact me at Julie.Boehmke@state.mn.us to discuss this claim. To the best of MnDOT’s
knowledge, there were no witnesses to the actual breach of the water main. Mary Wenner, MnDOT
Mendota Truck Station Supervisor, and John Rivard, MnDOT Drainage Crew Supervisor, have direct
knowledge of MnDOT’s damages and incurred costs. While I have included contact information for Ms.
Wenner and Mr. Rivard on the Notice of Claim Form, please contact me prior to contacting them.
I look forward to hearing from you.
2
Very Truly Yours,
Julie L. Boehmke
Associate Legal Counsel
Enc.
Equal Opportunity Employer
WORK ORDERMinnesota Department of
Vegetation Management
FY 2020 Date:
2
Time:
Page: 1 of
07/07/2020
11.39 AMWR/TE #:
Inv. Element Begin Measure Accomp.Route End Measure
108.01 1.00300000000000013-IMN 13 I RP 096+00.098 - 112+00.037 108.01
108.01 1.00300000000000013-IMN 13 I RP 096+00.098 - 112+00.037 108.01
06/10/2020Start Date:06/23/2020Cmpl. Date:(2) DefaultPriority
Comments:
Labor:
Employee Name Work Date Hours Labor Cost Arrived:Departed:TRC Time
Sisell, Brian 06/11/2020 9 $ 318.8701. REG - Base Pay
Grinnell, Paul 06/11/2020 9 $ 306.9901. REG - Base Pay
Leon, Jason 06/11/2020 9 $ 325.3501. REG - Base Pay
Cornell, Dallas 06/11/2020 9 $ 351.0001. REG - Base Pay
VanCura, Joseph 06/16/2020 9 $ 289.0801. REG - Base Pay
Cornell, Dallas 06/16/2020 9 $ 351.0001. REG - Base Pay
Leon, Jason 06/16/2020 9 $ 325.3501. REG - Base Pay
Whelan, Daniel 06/16/2020 9 $ 325.3501. REG - Base Pay
Rowe, James 06/16/2020 9 $ 278.3701. REG - Base Pay
Rowe, James 06/18/2020 8 $ 247.4401. REG - Base Pay
VanCura, Joseph 06/18/2020 8 $ 256.9601. REG - Base Pay
Equipment:
Equipment ID Equipment Class Work Date Total Hrs Mileage Equipment Cost
218286 CAB CHASSIS 14,001-19,500 06/11/2020 7 22 $ 40.04
217499 CAB CHASSIS 14,001-19,500 06/11/2020 7 29 $ 52.78
217082 PICKUP 8,501-14,000 06/11/2020 7 25 $ 23.75
97854 TRAILER, >10,000 GVW 06/11/2020 6 0 $ 76.44
215500 TRUCK, SINGLE AXLE >26,000 06/11/2020 7 38 $ 183.92
218286 CAB CHASSIS 14,001-19,500 06/16/2020 7 36 $ 65.52
217499 CAB CHASSIS 14,001-19,500 06/16/2020 7 25 $ 45.50
217082 PICKUP 8,501-14,000 06/16/2020 9 35 $ 33.25
216041 PICKUP 8,501-14,000 06/16/2020 9 48 $ 45.60
213005 TRUCK, SPECIAL APP >26,000 06/16/2020 9 48 $ 192.96
216041 PICKUP 8,501-14,000 06/18/2020 8 48 $ 45.60
213005 TRUCK, SPECIAL APP >26,000 06/18/2020 8 48 $ 171.52
Ditch repair/flushing SB13 @ 2nd Street Bike Trail
Ditch Cleaning - Washout RepairActivity:156 - No SubactivitySub-Activity:
7321 - Mendota Heights SubareaAdmin Unit:83968Work Order #:
Asset Type:
ICR #:
Section
Created By:CORN1DAL
Project ID (Chg #):TP9M0131
Status: (Closed) Ready to
Complete
$ 0.00Contract Cost:
Other Costs:
$ 3,375.76
$ 0.00
$ 976.88
$ 4,352.64
Labor Cost:
Material Cost:Work Order
Equipment $ 0.00
The costs shown below are summarized costs for the work order. On completion, these costs reflect the sum of
estimated costs based on work order day cards. When work order actuals are made available from the financial
Note:
WORK ORDERMinnesota Department of
Vegetation Management
FY 2020 Date:
1
Time:
Page: 1 of
07/07/2020
11.37 AMWR/TE #:
$ 0.00Contract Cost:
Inv. Element Begin Measure Accomp.Route End Measure
108.01 1.00300000000000013-IMN 13 I RP 096+00.098 - 112+00.037 108.01
06/08/2020Start Date:06/12/2020Cmpl. Date:(2) DefaultPriority
Comments:
Labor:
Employee Name Work Date Hours Labor Cost Arrived:Departed:TRC Time
Leon, Jason 06/08/2020 9 $ 325.3501. REG - Base Pay
Cortez, Margarito 06/08/2020 5 $ 180.7501. REG - Base Pay
Grinnell, Paul 06/08/2020 9 $ 306.9901. REG - Base Pay
Bedner-Faris, Margaret 06/08/2020 9 $ 306.9901. REG - Base Pay
Cornell, Dallas 06/08/2020 5 $ 195.0001. REG - Base Pay
Equipment:
Equipment ID Equipment Class Work Date Total Hrs Mileage Equipment Cost
215022 CAB CHASSIS 14,001-19,500 06/08/2020 0 25 $ 45.50
218286 CAB CHASSIS 14,001-19,500 06/08/2020 0 15 $ 27.30
217082 PICKUP 8,501-14,000 06/08/2020 0 25 $ 23.75
204250 PICKUP 8,501-14,000 06/08/2020 0 25 $ 23.75
210100 PICKUP <8501 06/08/2020 0 25 $ 21.75
Ditch Repair - SB13 @ 2nd St. Bike Trail
Other Costs:
$ 1,315.08
$ 0.00
$ 142.05
$ 1,457.13
Labor Cost:
Material Cost:Work Order
Equipment $ 0.00
Ditch Cleaning - Washout RepairActivity:156 - No SubactivitySub-Activity:
7321 - Mendota Heights SubareaAdmin Unit:83214Work Order #:
Asset Type:
ICR #:
Section
Created By:CORN1DAL
Project ID (Chg #):TP9M0131
The costs shown below are summarized costs for the work order. On completion, these costs reflect the sum of
estimated costs based on work order day cards. When work order actuals are made available from the financial
Note:
Status: (Closed) Ready to
Complete
WORK ORDERMinnesota Department of
Drainage Systems Inspection and
Maintenance
FY 2020 Date:
2
Time:
Page: 1 of
07/07/2020
11.35 AMWR/TE #:
05/28/2020Start Date:06/23/2020Cmpl. Date:(2) DefaultPriority
Comments:
Labor:
Employee Name Work Date Hours Labor Cost Arrived:Departed:TRC Time
Leon, Jason 05/28/2020 9 $ 325.3501. REG - Base Pay
Leon, Jason 05/28/2020 0.5 $ 24.4602. OVT - Overtime Pay
Leopold, Timothy 05/28/2020 0.5 $ 20.9902. OVT - Overtime Pay
Leopold, Timothy 05/28/2020 7 $ 220.6401. REG - Base Pay
Kampa, Julie 05/28/2020 0.5 $ 20.0002. OVT - Overtime Pay
Kampa, Julie 05/28/2020 6 $ 181.1401. REG - Base Pay
Hagle, Steffen 05/28/2020 4.5 $ 162.6801. REG - Base Pay
Blankholm, Andre 05/28/2020 7 $ 253.0501. REG - Base Pay
Blankholm, Andre 05/28/2020 0.5 $ 24.4602. OVT - Overtime Pay
Rivard, John 05/28/2020 5 $ 243.4501. REG - Base Pay
Whelan, Daniel 05/28/2020 8 $ 289.2001. REG - Base Pay
Whelan, Daniel 05/28/2020 0.5 $ 24.4602. OVT - Overtime Pay
Oldenkamp, Mark 05/28/2020 7 $ 253.0501. REG - Base Pay
Oldenkamp, Mark 05/28/2020 0.5 $ 24.4602. OVT - Overtime Pay
Pavek, Timothy 05/28/2020 9 $ 351.0001. REG - Base Pay
Pavek, Timothy 05/28/2020 0.5 $ 26.6002. OVT - Overtime Pay
Wenner, Mary 05/28/2020 9 $ 478.2601. REG - Base Pay
Wenner, Mary 05/28/2020 0.5 $ 26.5702. OVT - Overtime Pay
VanCura, Joseph 05/28/2020 4.5 $ 144.5401. REG - Base Pay
VanCura, Joseph 06/01/2020 9 $ 289.0801. REG - Base Pay
Pavek, Timothy 06/01/2020 5 $ 195.0001. REG - Base Pay
Knandel, Ryan 06/01/2020 9 $ 283.6801. REG - Base Pay
VanCura, Joseph 06/11/2020 9 $ 289.0801. REG - Base Pay
Rowe, James 06/11/2020 9 $ 278.3701. REG - Base Pay
Equipment:
Equipment ID Equipment Class Work Date Total Hrs Mileage Equipment Cost
217499 CAB CHASSIS 14,001-19,500 05/28/2020 6 2 $ 3.64
213461 EXCAVATOR, SPECIAL APP 05/28/2020 4.5 $ 821.88
217396 INDUSTRIAL LOADER, >2.0 CY 05/28/2020 7 8 $ 561.82
218002 PICKUP 8,501-14,000 05/28/2020 9 15 $ 14.25
218415 PICKUP <8501 05/28/2020 5 31 $ 26.97
213006 PICKUP <8501 05/28/2020 9 15 $ 13.05
218084 TRAILER, >10,000 GVW 05/28/2020 4.5 26 $ 57.33
210516 TRUCK, SINGLE AXLE >26,000 05/28/2020 6 6 $ 29.04
213005 TRUCK, SPECIAL APP >26,000 05/28/2020 4.5 51 $ 96.48
211567 TRUCK, TANDEM AXLE >26,000 05/28/2020 8 46 $ 205.16
204552 TRUCK, TANDEM AXLE >26,000 05/28/2020 7 30 $ 133.80
WATER MAIN BREAK/CLEANUP
CleanActivity:156 - No SubactivitySub-Activity:
7321 - Mendota Heights SubareaAdmin Unit:82066Work Order #:
Asset Type:
ICR #:
Pipe
Created By:WENN1MAR
Project ID (Chg #):TP9M0131
Status: (Closed) Ready to
Complete
$ 0.00Contract Cost:
Equipment:
Equipment ID Equipment Class Work Date Total Hrs Mileage Equipment Cost
206557 TRUCK, TANDEM AXLE >26,000 05/28/2020 7 30 $ 133.80
205550 TRUCK, TANDEM AXLE >26,000 05/28/2020 4.5 26 $ 115.96
216041 PICKUP 8,501-14,000 06/01/2020 9 51 $ 48.45
218002 PICKUP 8,501-14,000 06/01/2020 5 15 $ 14.25
213005 TRUCK, SPECIAL APP >26,000 06/01/2020 9 51 $ 192.96
216041 PICKUP 8,501-14,000 06/11/2020 9 26 $ 24.70
213005 TRUCK, SPECIAL APP >26,000 06/11/2020 9 26 $ 192.96
Other Costs:
$ 4,429.58
$ 0.00
$ 2,686.50
$ 7,116.08
Labor Cost:
Material Cost:Work Order
Equipment $ 0.00
The costs shown below are summarized costs for the work order. On completion, these costs reflect the sum of
estimated costs based on work order day cards. When work order actuals are made available from the financial
Note:
Photo # 1 shows roadway/ditch before cleaning & MnDOT truck.
Photo # 2 shows ravine flowing towards roadway & MnDOT truck.
Photo #3 shows ravine slope failure.
Photo #4 shows ravine draining to Hwy 13 and includes patrol.
Photo # 5 shows washout on downstream side of 13 under guardrail.
Photo # 6 shows sediment coming out of the drainage culvert along 2nd St.
Photo #7 shows maintenance cleaning ditches.