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Roers, MauriceRevised March 2023 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 this completed form to the Saint 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: Maurice Last Name: Roers Please Indicate Your Pronouns: ☐ She/Her/Hers, ☒ He/Him/His, ☐ They/ Them/Theirs Company or Business Name: N/A 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? NO If yes, what is your File Number? N/A If yes, provide your Insured’s/ Client’s Name: N/A Street Address: 1298 Folsom Street City: Saint Paul State: MN Zip Code: 55117 Daytime/Work Phone: 612-816-6799 Cell Phone: 612-816-6799 Date of Incident or Date Discovered (Must Complete): October 11, 2023 – likely date of damage, discovered November 15, 2024 Click or tap to enter a date. Time: Unknown Please state, in detail, what happened that prompted you to file a Notice of Claim Form: I believe that the Saint Paul Regional Water Service’s replacement of a water supply line on October 11, 2023 at 1299 Folsom Street resulted in damage to my sewer connection at 1298 Folsom Street. A letter from the City was issued to me on November 30, 2023 notifying me that I was required to repair my broken sewer connection at a cost of $9347. In December 2023, I received notice sent from the Saint Paul Department of Public Works on November 23, 2023 that they believed my residential sewer connection had failed. Specifically, it appeared that the join between my line and the City’s sewer had become disconnected. That notification indicated that I was responsible for getting it fixed within 15 days. I was overseas at the time and arranged for my sewer connection to be repaired in January 2024. I return to the U.S. in June 2024. In November 2024, I ran into the owner of 1299 Folsom Street which is directly across the street from my property at 1298 Folsom Street. In speaking with him, he alerted me to the fact that the Saint Paul Regional Water Service (SPRWS) had replaced the lead water supply service to his house on October 18, 2023, which was just a few weeks prior to my being notified of the sewer issue. The location of the 1299 Folsom water supply line and the 1298 Folsom sewer connection are directly opposite to each other and separated by only 5-8 ft. I believe that the SPRWS’s work at 1299 Folsom Street damaged, either through vibration or settlement, the sewer connection at 1298 Folsom Street. I believe that the SPRWS work precipitated the damage to my property for the following reasons:  My home at 1298 Folsom Street was built in 1908, and its sewer connection had been stable for 100+ years until late 2023.  On October 11, 2023, the Saint Paul Regional Water Service excavated the area adjacent to my sewer connection to replace the water supply at for 1299 Folsom Street (Permit #21328318, Gopher State# 213190138). Within 2-4 weeks following that work, the City’s Dept of Public Works identified a sewer issue at 1298 Folsom in November 2023.  As per the advice in City’s November 30th letter, I arranged a televised inspection in December 2023 of the sewer line at 1298 Folsom Street. That video showed that the sewer was in good condition but for a broken join where it meets the Revised March 2023 City’s sewer adjacent to the site of the SPRWS work. There was no other noticeable settling, intrusion of roots, or other issues with the sewer that would precipitate a failure at its connection with the City sewer.  Sewer issues commonly take 2-4 weeks to reveal themselves meaning the sewer connection became broken at the same time that the adjacent SPRWS works occurred. Again, for a sewer that was stable for a 100+ years, this is more than coincidental.  The SPRWS work at 1299 Folsom Street was in close proximity to the sewer connection for 1298 Folsom Street. While the two assets, on plan, are meant to be 7 lateral feet apart, the actual physical works appears to have been much closer. See the attached photos which shows where the SPRWS repair cut for 1299 Folsom was made. This is <5 feet away from the surveyed location of the sewer.  The site of the SPRWS work for 1299 Folsom Street shows a physical connection between the location of that work and the failed sewer connection at 1298 Folsom Street. The attached photos show how the settling of the pavement from the failed sewer connection runs to the site of the SPRWS water supply work. If there was no connection between the SPRWS repair work and the failed sewer, why is there a clear physical connection between the two sites? Why does the settlement of street pavement, attributed to the failed sewer, run towards and connect to the site of the water supply work?  Contractors for SPRWS had to return to 1299 Folsom Street in August 2024 to do additional corrective work due to the extent of settling of their October 2023 repairs. Please state why or how you feel the City of Saint Paul is responsible for your Damages? The City, through its affiliate the SPRWS and their work at 1299 Folsom Street, dislodged the sewer connection for my property at 1298 Folsom Street. The failure of the sewer connection at 1298 Folsom Street would not have occurred but for the disruption created SPRWS’s excavation for the 1299 Folsom Street water supply. Please see the evidence and rationale above demonstrating the connection between the SPRWS work and the damaged sewer. 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: N/A If yes, what law enforcement agency responded? N/A Where did the incident take place? Please provide a street address, intersection or name of city park or facility: 1298 & 1299 Folsom Street Revised March 2023 What would you like to see happen to resolve this claim to your satisfaction? I would like to be reimbursed $9347 for the costs I paid to have my sewer connection repaired (see attached invoice). This resolution does not include the personal time lost in organizing the repair and pursuing this claim. Were there witnesses to this incident? Please provide names and contact phone numbers: Chad Erickson (612-245-9930) is the owner of 1299 Folsom Street. He is knowledgeable of the SPRWS works and can speak to his observations of the quality of that work (e.g. extent of ground settlement and make good work that was required). 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: ______________________________________________________ Other property damaged: Damaged connection between the private sewer connection at 1298 Folsom Street and the City sewer. For injury claims of any type. – Not applicable 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: Maurice Roers Signature of Person submitting this form: _______________________________________________________ Relationship of person signing to Party making the claim: One and the same Choose an item. Date document is being signed: 11/27/2024 Revised March 2023 Attachment #1 – City Letter Identifying Sewer Issue Revised March 2023 Attachment #2 – City Letter Directing Repair of Sewer Revised March 2023 Attachment #3 – Photo 1 The first photo, taken from the upstairs of 1298 Folsom Street, shows the location of the water service work at 1299 Folsom Street and the sewer connection to 1298 Folsom Street. 1299 Folsom Street is located on the far side of the street and the location of the SPRWS work is the fresh rectangle of asphalt directly in front of the disturbed soil. The sewer connection for 1298 Folsom Street to the City sewer is towards the center of the street, again in direct alignment with the SPRWS site. The location of the sewer is shown by the light blue survey marks relating to an upcoming City street renovation. Note that the physical link between the SPRWS work site and the broken sewer connection – e.g. the settling of the street asphalt is shown by the pooled water which runs to/from the SPRWS work site and to the location of the broken connection with the City sewer. Revised March 2023 Attachment #4 - Photo 2 The second photo shows the distance from the excavation by SPRWS and the City sewer which was less than 5 feet. I do not know what shoring or other methods were used by the SPRWS to ensure that the sewer connection was protected from vibration or settlement. Note too the settlement of the City sidewalk in the location of the SPRWS work. In August 2024, contracts had to return to the site to place additional fill as the berm had settled 2+ feet – e.g. an indication of quality of the water supply work and the likelihood that it resulted in wider disturbance. Revised March 2023 Attachment #5 - Photo 3 & 4 The third and fourth photos are a street level view which provides greater visibility of the settlement of the street asphalt. Again, it cannot be the case that there was no connection between the SPRWS work and the failed sewer when the settlement of the pavement shows a clear physical connection. Revised March 2023 Attachment 5 – Invoice for Sewer Repair Revised March 2023 Attachment #6 – Sewer Inspection Video Below is a still from the inspection video. The full video can be viewed in the attached link https://drive.google.com/file/d/10ly8V6I1WfHm91af6TmbMP8djk6iaPY6/view?usp=sharing and shows that the condition of the 1298 Folsom Street’s sewer is in good condition and does not show deterioration.