Williams, Jeannie
JNOTICE 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 this completed form to the
mailto:Saint%20Paul%20City%20Clerk’s%20OfficeSaint Paul City Clerk’s Office by email (cityclerk@ci.stpaul.mn.us), fax (651-266-8574) or mail addressed to “Saint Paul City Clerk, 15 West
Kellogg Blvd., Suite 310, Saint Paul, MN 55102”.
Claimant: First Name: _____Jeannie Williams_____________ Last Name: ___Williams______________________________________
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? YES / NO If yes, what is your Claim/File Number? <_________________________
Is this claim being made by an Attorney? YES / NO If yes, what is your File Number? _______________________________________
If yes, then provide your Insured’s/ Client’s Name ___________________________________________________________________
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Street Address: ______583 Burgess Street________________________________________________________________________
City: ___________Saint Paul____________________ State _____MN_________________ Zip Code ____55102_______________
Daytime/Work Phone _______612-986-6216___________________ Cell Phone __________________________________________
E-mail _________________jeanniemarieart@gmail.com________________________________
Date of Incident or Date Discovered (Must complete) 8/8/2024Time _____3:00 pm_______________________
Please state, in detail, what happened that prompted you to file a Notice of Claim Form. An abatement order was sent for ALLEY overhang shrubbery growth. We cleaned the alley prior
to the deadline date on the abatement notice and trimmed the tree overhanging ROW (June 15) We had also trimmed shrubs in front of the house along the fence at the same time. Being
that we took care of the abatement we were under the assumption that since no work was to be done, we would not be charged for cleaning up our own property.Crews arrived at 3:00 pm (on
our surveillance cameras) on 8/8/24 and removed all the private bushes and shrubs along the FRONT of the house that were not impeding or overhanging – they were behind our chain link
fence. All the vines were removed from our fence that had been providing much needed privacy and shade. Our cameras show NO work done in the alley (as we completed the requested work
prior to the deadline) and show crews butchering our plants and removing all shrubs and vines from the private property fence.
Please state why or how you feel the City of Saint Paul is responsible for your Damages? _ The work to be abated was completed prior to the City’s deadline and the City’s contractors
erroneously removed mature grown on private property in a completely different area of the property, none of which was in violation of City Code.The vines, ornamental trees and growth
has been over 15 years in the making and created safety, shade and privacy to the front windows of the home and the fence. The City now intending to fine us for the work done (which
was done in error) that violates MN State Statute 501.04 (https://www.revisor.mn.gov/statutes/cite/561.04)
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.
Continue to page 2 of Notice of Claim Form. Failure to complete and return both pages will result in delays.
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: ___________________________
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.
_583 Burgess Street Saint Paul MN 55103 _______________________________________________________________
What would you like to see happen to resolve this claim to your satisfaction? Removal of fine as the work was completed by the homeowner prior to the city’s deadline. And financial compensation
for the complete destruction of property and privacy so that we can try to replace the plant life that was removed and destroyed to gain back privacy.
Were there witnesses to this incident? Please provide names and contact phone numbers: </w:t></w:r></w:sdtContent></w:sdt><w:r w:rsidR="0031571E" w:rsidRPr="00 Surveillance cameras
owned by property owner show NO work being done in the alley and crews removing private landscaping/shrubs/and vines that are not code violations located on the chain link fence and
front side of the house.
For property damage claims, including vehicle accidents.
Your vehicle’s information: Year _________ Make _________________ Model __________________ Color ____________________
License Plate # _________________________ State vehicle is registered in ___________________________
Registered owner of vehicle ______________________________ Driver __________________________________________
Area(s) damaged ______________________________________________________________________________________
If a City vehicle was involved: License Plate # _________________________________ Color _________________________________
Was there City insignia on the vehicle? YES / NO Driver’s Name </w______________________________________________________
Other property damaged: Private shrubs behind the property line, which included Buckthorn, lilac bushes/trees, raspberry bushes/vine, Boston ivy all along the fence and front gate to
property
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. _________________________
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: _______Jeannie Williams ______________________________________________________ <
Signature of Person submitting this form: _______________________________________________________
Relationship of person signing to Party making the claim: SELF
Date document is being signed 8/13/2024__
Revised March 2023