Pollard, CourtnieNOTICE 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 Courtnie Last Name Pollard
Please Indicate Your Pronouns: She/ Her/Hers ☒ He/Him/His ☐_ They/ Them/Theirs ☐
Company or Business Name: ______________________________________________________________________________
Is this claim being made by an Insurance Company? NO If yes, what is your Claim/File Number?: _____________________
Is this claim being made by an Attorney? NO If yes, what is your File Number? _______________________________
If yes, then provide your Insured’s/ Client’s Name ____________________________________________________________
Street Address: 241 Kellogg Blvd E. Apt. 414
City: St. Paul State Minnesota Zip Code 55101
Daytime/Work Phone 3373688737 Cell Phone 3373688737
Date of Incident or Date Discovered (Must complete) 3/13/2023 Time around 19:30
Please state, in detail, what happened that prompted you to file a Notice of Claim Form. On the above stated time and date, I
encountered a pothole while traveling on Robert St. heading in the direction towards Kellogg Blvd before getting to the Cesar
Chavez St. intersection. One front tire was popped, immediately flattening it, while the other tire ended up with a bulge in it,
rendering it weakened and prone to popping. Click or tap here to enter text.
Please state why or how you feel the City of Saint Paul is responsible for your Damages?
Under MSA 466.02, every municipality is subject to liability… acting within the scope of their employment or duties….
Liability/negligence requires the existence of the duty of care, a breach of that duty, proximate cause, and an
injury/damages. Generally, Minnesota holds a municipality responsible for negligence in maintaining the safety of its
street and sidewalk surfaces. Hansen v. City of St. Paul, 298 Minn. 205, 207, 214 N.W.2d 346, 348 (1974). The city has
a duty to maintain and inspect roadways, provide warning of unsafe conditions, and repair defects in the roadways.
The city also has a duty to create a policy to implement such maintenance and inspections and to follow that policy.
These duties are to keep the streets in a reasonably safe condition for the public.
The accident in question occurred in the City of St. Paul on Robert Street, heading towards Kellogg Blvd, before the
tunnel/overpass around Cesar Chavez Street. This road is pretty busy, thereby warranting a need for frequent
maintenance and inspection.
“Constructive knowledge is established through evidence that the dangerous condition was present for such a period
of time that it constituted constructive notice of the danger. White v. City of N. St. Paul, No. A03-191, 2003 WL
22952103, at *2 (Minn. Ct. App. Dec. 16, 2003), citing Rinn v. Minn. State Agric. Soc’y, 611 N.W.2d 361, 365
(Minn.App. 2000). “Inadequate inspection or failure to discover the existence of a defect is not a separate ground for
liability, but will bear on the proof of constructive notice.” Kopveiler v. N. Pac. Ry. Co., 280 Minn. 489, 493, 160
N.W.2d 142, 146 (1968). Thus, constructive knowledge is established where “the municipality in the exercise of
reasonable diligence to discover and remedy defects should have known of its existence.” Id. Foreseeability of an
injury is dependent on whether the possibility of an accident would be clear to an ordinary, prudent person and
weighs on whether the degree of care required was exercised. Van Gordon v. Herzog, 410 N.W.2d 405, 408 (Minn. Ct.
App. 1987).
It's foreseeable that potholes would occur due to the large amount of snow and thawing, particularly on frequently
trafficked streets, and that vehicles would be damaged by these potholes. St. Paul Public Works has made the public
aware of their knowledge that the potholes are a bit bigger this year and that there a bit more of them in an interview
with Fox 9. The director of Public Works also stated to CBS on March 9th that “[t]his year is probably the worst that
it’s been in a generation,” and that “we’re absolutely in a record-setting pothole year.” The area of the pothole I
encountered hasn’t been seal coated since 2019, thereby leaving it more vulnerable to the abundance of snow this
year. This winter has edged, and possibly made it into, the top 10 snowiest winters in history, and it’s not even the
end of the season yet. A plan doesn’t seem to have been put in place until the last few weeks, even though the winter
has been pretty brutal since December. Therefore, the city had constructive notice and breached its duty by not
diligently maintaining, inspecting, or repairing the pothole, and by not reasonably anticipating, adapting, and
implementing an adequate policy to account for the increased amount of snow, size of potholes, and amount of
potholes. Furthermore, this particular pothole was deep enough to cause one tire to pop and another one to have a
bulge, meaning the pothole must have been there for a reasonable amount of time without repair.
My car is a 2019 model, has had regular inspection and maintenance, and is under the mileage required for new tires.
There was nothing structurally wrong with the tires before driving on this road and encountering a pothole. The
pothole, the existence of which is due to the city’s negligence, caused one tire to pop and another one to have a
bulge, thereby weakening the tire and leaving it prone to further damage.
The damage incurred was the amount of replacement for the two tires, which totaled $458.63. The invoice is attached
to this form.
I did not take pictures of the damaged tires; however, I do have the claim number for the State Farm Roadside
Assistance I requested on March 14, 2023 to have the flat tire replaced with the spare tire: 23-L863-8P4. If needed, I
could obtain a written statement from the Salesperson from Discount Tire, Thomas B, to verify the damage to the
tires.
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? NO If yes, please provide the police report case number ____________________
Revised December 2021
If yes, what law enforcement agency responded? _______________________________________________________
Where did the incident take place? Please provide a street address, intersection or name of City park or facility.
________________________________________________________________________________________________________
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? I would like a full refund for the replacement of my
tires caused by the pothole in the amount of $458.63.
Were there witnesses to this incident? Please provide names and contact phone numbers. ______________________________
For property damage claims, including vehicle accidents.
Your vehicle’s information: Year 2019 Make Toyota Model Camry Color Grey
License Plate # GJU757 State vehicle is registered in Minnesota
Registered owner of vehicle Courtnie Pollard Driver Courtnie Pollard
Area(s) damaged Both front tires
If a City vehicle was involved: License Plate # _______________________________ Color _______________________________
Was there City insignia on the vehicle? Yes No Driver’s Name _____________________________________________
Other property damaged: ___________________________________________________________________________________
For injury claims of any type.
What part of your body was injured? __________________________________________________________________________
Did you go to the emergency room or urgent care? Yes No Where? _________________________________________________
Was medical treatment received? Yes No Where? ______________________________________________________________
First day of medical treatment? _____________ Are you still receiving medical treatment? Yes No
Did you miss any work as result of this incident? Yes No Employer(s) _______________________________________________
How much time have you missed from work?___________________________________________________________________
If you are submitting other documents, please state what you are attaching and how many pages. I am attaching the invoice from
Discount Tires establishing the amount of damages and a screenshot of my State Farm app showing the Claims Number for the
Roadside Assistance claim on 3/14/23 for the service on the flat tire. These equal to 3 pages.
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: Courtnie Pollard
Signature of Person submitting this form: _______________________________________________________________________
Relationship of person signing to Party making the claim: ___________________
Date document is being signed 3/20/2023
Revised December 2021