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Lazarus - - REC����G� . March 12, 2012 _ MAR 13 �p�� Dear Ms. Quicksell: �IT`:j t;,,��{� I am responding to your note of late December regarding the damage to the mailbox in front of our house that was damaged when the Services' crew was repairing the main in the street. It was difficult to get an estimate of the cost to fix it in the middle of winter because the mailbox post needs to be dug out of the ground and replace and the first request I made for an estimate was "Wait until spring." Enclosed is your claim form, a copy of the estimate I received, and a series of photos I took of the damage the day or two after it happened. Would you let me know if I can supply you with any further information about this. Yours truly, Maurice Lazarus u�� I� I �a-aa�I� Y�1�� ��Y�� - �a�r ►ma��l l�x was � � I�s+ ���►f by rv� pv�� o-F ��,v Ve h►Gp.eS . Zf o� �n�G� Ii 1� -b��l� � , �,�� ��� a cl��m , �(�� ��,�I i� Q�}.�d --f�,Ym �.�d- -�-� �+��e�s s�.�ah. ��� cai� �'f a�� ���s�w� s, �I� 6Z March 12, 2012 - Dear Ms. Quicksell: I am responding to your note of late December regarding the damage to the mailbox in front of our house that was damaged when the Services' crew was repairing the main in the street. It was difficult to get an estimate of the cost to fix it in the middle of winter because the mailbox post needs to be dug out of the ground and replace and the first request I made for an estimate was "Wait until spring." Enclosed is your claim form, a copy of the estimate I received, and a series of photos I took of the damage the day or two after it happened. Would you let me know if I can supply you with any further information about this. Yours truly, Maurice Lazarus , s _r � �a-aa�l� V1��� ��Y�� - �n�tr ��") l�x was � � I�s+ ���f by �� o✓►� of D�,v Veh�G��eS . zf r,y,� �n�d i,�e ���I� � � -fi'I10�.+-�. G� C IG�i tim � �1�� a{}.�p� -FoYm �.v�- V��i'I �� "�`j-i'he G���ess sl�n. �A-�°. caii �'f a�� ���firm s, L�� 6Z. NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota Minnesota State Statute 466.OS 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 needcd,a.rtac�� additional sheets. Please note that you will not be contact�ed by telephone to clarify answers,so provide as much i�formation 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 comp�eted. If something does not apply,write`l'�1/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102 � First Name �v`a�����;p_ Middle Initial (�Last Name �2r.�!'� � � Company o��Business Name . Are You_an Insurance Compail}!2__Y�If Yes,Clai� »ro .r� __ __ _____ __ Street Address I l� �, ��a.t� �.i e.����� City �� ,1�(�t,� �t�.(J� State (�� Zip Code �=�1\Y� Daytime Phone(��-�Cell Phone(� - Evening Telephone(�) �-� �i�-l�� Date of Accident/Injury or Date Discovered t�•ZI � i 1 TimeSi;,��, am pm , —� . Please stat.e.,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 amages. � � � � ��� � ; � C� o �� � ��, � 10 • 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 C� My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property �Other type of properiy damage—please specify �i���h ❑ Other type of injury—please specify " In order to process your claim vou need to include copies of all apnlicable 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 WII.,L NOT be returned and become the property of the City. You are encouraged to keep a copy for yourself before submitting your claim form. I O 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 O Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt O 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 O Injury claims: medical bills,receipts O Photographs aze always welcome to document and support your claim but will not be retumed. 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—qlease complete this section Were there wimesses to the incident? Yes No Unknown (circle) Provide their names,addresses and telephone numbers: --5 U�� : � c• _ Were the police or law enfarcement called? Yes o� Unl:nown (circle) If yes,what department or agency? Case#or report# 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. ���X� � �l�.� � 1�`>l� �Q.0�.�.�1 � � �. �L11���C �N Ci�/. -. \ 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. ��� Velticle Cla��ns—ptease complete this seetir��i ❑ check box if this section does not appl�, Your Vehicle: Year ?��ake � Mode1 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 � Iniurv Claims—please comp(ete this section ❑ 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 I Did you miss work as a result of your injury? Yes No When did you miss work? (provide date(s)) I�Tame of your En-�ployer: Address Telephone �Check here if you are attaching more pages to this claim form. Number of additional pages�. 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 ���)Z Print the Name of the Person who Completed this Form: V V\v�u�^�C_+2_._ ��.c�U"l:� Signature of Person Making the Claim: � Revised February 2011 /�� �,�F '��:'�'���`v - P RO P O SA L r c � ; \�L,' I ^�� F_ - � )�/� �� . l �� PROPOSAL NO. —. � SHEET NO. `a� /c.�. DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME ADDRESS ��. � �... � � j(,l.� ADDRESS CITY,STATE /C- Sti f�,�;✓'_,F---�t� -�(�;l.� i�l� CITY,STATE `.,� � DATE OF PLANS ���.,' r1� .�� ll� PHONE NO. ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of �_,s�._.� i��q,,.�J�`�, �� ,' j�j ;,, .J,f�=; _.�! ) ; •��2j's- rt, C. --� L.�'��- � !+� ,'��(..v �r'L--�C.�"��' � 7cJ t�� %/;sf�t�,,...t`� s7 'C ` T'%-�i,J`��-i /�5' Y`.::.✓�1.vC ,tiJ ,�=:JC..�� i L -;� T;� �t. _�{� ;�•%c'Nr� t-f� `�7 ..) t�::i� {,: Sv�.r. Q(= ! ��, �r r '�AC � G - k I!aC'ta-�s r2of, f',�,� (Tc., i; ��, ,: p� d.�:- '',i �Ca� �G' .C,i '►' � li�.�S^ 1�!'t'�= 'C" ` � /��-'%(-��/:fC..S (c-I r�t�-�n1' - X I S— �.�X f' 4�.)�-t,�- �i�� ''(J' �' � ,�J � v�� t� � �C.i< �!S All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitte r abov work and compl d in a sup�stantial workmaniike manner for the sum of: �U { l_ _f, igCy�..� ��C,�.,.�,p� ; �� � - T Uf�„n���,.--�....Dollars (R ��"'� --- ) with payments to be as follows ' J� 1 /' , K j Any aNerations or deviation imm above specifications involving extra cosis Respectfully submitted . will be executed oNy upon wntten ortler,and will become an eutra charge �,. over and above ihe estimate. All agreements contingent upon sinkes, 'y;'�l� accitlents,or delays beyond our conirol. Pe( � ��'�4`�/y„s—�� � T� Note-This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments wili be made as outlined above. 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