Vang, Mee
NOTICE 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 answers to each question. If you have additional documentation you may add those
documents to your submission. You will not be contacted by telephone unless clarification is needed. The claim process for investigations can take upwards of
four (4) weeks. This form must be signed, dated with all applicable sections completed. Submission is to the Saint Paul City Clerk’s Office. You may email, fax
(651-266-8574) or mail the form. Mailing address is “Saint Paul City Clerk, 15 West Kellogg Blvd., Suite 310, Saint Paul, MN 55102”
Individuals: First Name Mee Last Name Vang
Please Indicate Your Pronouns: She/ Her/Hers ☒ He/Him/His ☐_ They/ Them/Theirs ☐
Company or Business Name: Gallagher Law Firm
Is this claim being made by an Insurance Company? NO If yes, what is your Claim/File Number?: N/A
Is this claim being made by an Attorney? YES If yes, what is your File Number? 22-013
If yes, then provide your Client’s Name Mee Vang
Street Address: 932 Albemarle Street
City: St. Paul State MN Zip Code 55117
Daytime/Work Phone _______________________________ Cell Phone ____________________________________________
Date of Incident or Date Discovered (Must complete) 1/31/2023 Time 6:30pm
Please state, in detail, what happened that prompted you to file a Notice of Claim Form. Mee Vang was driving WB on Maryland
Ave in the left lane toward Rice St. She used her left turn signal and merged into the left turn lane, intending to go SB on Rice St.
Fully marked squad car #2162 had been behind her before she moved into the turn lane. Once she was in the turn lane, the squad
car pulled up next to her, and maneuvered into her vehicle, causing the collision. Mee Vang suffered injuries due to this collision.
Please state why or how you feel the City of Saint Paul is responsible for your Damages? Fully marked squad car #2162 had no lights
or sirens on before, during, or after the collision, and was being driven by Officer Ricardo Perez Estrella, who was believed to have
been on duty at the time of the accident. Mee Vang lawfully entered the turn lane, and Officer Perez Estrella failed to keep aware of
other vehicles and merged into her, causing the accident.
Please check the reason that most closely describes the reason for your submitting a claim. Please note the documents that will
need to be provided with your completed form. Photographs will be accepted. All documents submitted become the property of
the City of Saint Paul and shall not be returned.
☐ Automobile damage from a motor vehicle accident: please provide two estimates for repairs or actual bill that has been paid.
☐ Automobile damage from a street defect or pothole : please provide two estimates for repairs or actual bill that has been paid.
☐ Automobile was towed and may or may not have sustained damage: please provide copy of towing ticket (if available), receipt
from Impound Lot, and two estimates for repairs or actual bill that has been paid.
☐ Snow Emergency: please provide copy of towing ticket (if available), receipt from Impound Lot, and two estimates for repairs or
actual bill that has been paid.
☐ Property damage: please provide two estimates for repairs or actual bill that has been paid.
☒ You were injured during a motor vehicle accident: please provide police report number, details about injury.
☐ You were injured in the City of Saint Paul: please provide police report number, witnesses and details about injury.
This section must be completed for all claims.
Is there a police report for this incident? Yes No If yes, please provide the police report case number 23-017422
Revised December 2021
If yes, what law enforcement agency responded? St. Paul Police Department
Where did the incident take place? Please provide a street address, intersection or name of City park or facility.
Intersection of Maryland Ave and Rice Street
Notice of Claim Form, page two. Failure to complete and return both pages will result in delays.
What would you like to see happen to resolve this claim to your satisfaction? Please contact Ms. Vangs attorney, at 651-222-4466
Were there witnesses to this incident? Please provide names and contact phone numbers. Nou Yang; 612-552-0652
For property damage claims, including vehicle accidents.
Your vehicle’s information: Year 2013 Make Toyota Model Tacoma Color Red
License Plate # BGL050 State vehicle is registered in MN
Registered owner of vehicle John Sou Thao Driver Mee Vang
Area(s) damaged Passenger side headlight/bumper. See photos
If a City vehicle was involved: License Plate # Police 2162_ Color Black
Was there City insignia on the vehicle? YES Driver’s Name Officer Ricardo Perez Estrella
Other property damaged: ___________________________________________________________________________________
For injury claims of any type.
What part of your body was injured? Headaches, R shoulder, R side neck, R arm, hip, upper & low back, hip, feet, both legs, 2 large
bruises on L thigh
Did you go to the emergency room or urgent care? YES Where? Regions Hospital
Was medical treatment received? YES Where? Capitol Health Center
First day of medical treatment? 2/8/2023 Are you still receiving medical treatment? YES
Did you miss any work as result of this incident? NO Employer(s) N/A
How much time have you missed from work? N/A
If you are submitting other documents, please state what you are attaching and how many pages. SPPD Incident Report, 23pgs;
vehicle damage photos, 4pgs
By signing this form, you agree that all information provided is true and correct to the best of your knowledge.
Please NOTE that submitting a false or misleading claim can and will result in prosecution under Minnesota Statutes.
Name of Person completing form: Patrick M. Conlin
Signature of Person submitting this form: /s/ Patrick M. Conlin _
Relationship of person signing to Party making the claim: Attorney
Date document is being signed 3/9/2023
Revised December 2021