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Johnson, Craig � � Minnesota Insurance Center American Arbitration Association Fi�CE�� Kathryn Stifter Dispute Resolution Services Worldwide VicePresident MAR 1 3 2012 �. ,� t�, �� March 12, 2�I Z U.S.Bank Plaza,Suite 70f�,��04 Sb��Veet,Minneapolis,MN 55402-1092 telephone:612-332-6545 facsimile:612-342-2334 intemet:http://www.adr.org/ John D. ScottlFile 14784 Bennerotte&Associates 3340 Sherman Court, #100 Eagan, MN 55121 Claims Representative City of St.Paul 15 Kellogg Blvd. West St. Paul, MN 55102 - ----- _ __ Re: 56 600 01303 12 Craig Johnson and City of St. Paul Claim File Number: Unknown Accident Date: Apri126,2011 Pol#: Self Insured Pol H1d:City of St. Paul Dear Parties: '' The American Arbitration Association has received a petition far mandatory No-Fault arbitration, pursuant to M.S.A. 65B.525. Enclosed to the Respondent is a copy of the petition and itemization of claim. This case will be administered according to the Minnesota No-Fault Arbitration Rules effective June 1, 2010. The Rules can be found on our website at: www.adr.org. The Claimant has requested that the hearing be held in the Twin Cities, Minnesota. Absent objection from the Respondent, we will submit a list of potential arbitrators from within a 50-mile radius of the requested locale in accordance with Rule 14. Pursuant to Rule 5(�, Respondent has thirty days to file a response to the petition. We request that two copies of the response be sent to the Association and one copy to the Claimant. Ylease use our case number on all correspondence to our office. Filing fees not already paid will be billed in accordance with Rule 39. Absent notice to the contrary, we will proceed with the administration of this case sending all correspondence to the above-named addresses. If you have any questions,please call the undersigned. Very truly yours, Kelly A. Baker Senior Case Manager 612 278 5106 BakerK@adr.org Enclosure(s) KAB/s f . I � . B ENNEROTTE & AS S O C IATES, PA Helpingyou... when help is needed most.T''� TOM BENNEROTTE CONORTOBINt MA�Ch g�2�12 Jo�r scoz-r Attorneys at Law American A.rbitration Association tAlsoadmitmdinWisconsin 700 Pillsbury Center 200 South Sixth Street Minneapolis,MN 55402 Re: Craig Johnson, Sr.v. City of St. Paul My File No.: 14784 Respondent's Claim No.: Unknown to Petitioner Dear Sir/Madam: Enclosed for filing on behalf of Claimant in the above-referenced matter are the following documents: 1. Petition for Arbitration; 2. Itemization of Claim; 3. Itemized billings and other supporting documentation; and _ The$45.00 filing fee has been paid online via credit card. � - No denial letter is enclosed,as there is none currently in Claimant's possession. However,medical benefits submitted and unpaid are from over 30 days ago. _ Claimant therefore relies upon Rule 5(d)of the Minnesota No-Fault Arbitration Rules - to activate entitlement to arbitrate this no-fault claim. Sincerely, BE O'TTE ASSOCIATES,P.A. , John D Scott _ _ _ _ Attorne at Law JDS/slt Enclosures ` cc: Craig Johnson, Sr. 3340 Sherman Court,Suite 100.Eagan,MN 55121 = PH:651-203-5990.FAX:651-288-0860.wwwbennerotte.com i AMERICAN ARBITRATION ASSOCIATION PETTTION FOR NO-FAULT ARBITRATION The named Claimant(s),pl.usuant to M.S.A. 65.B525,hereby tender(s)the following dispute arising out of a no-fault insurance policy for resolution under the Minnesota No-Fault Comprehensive or Collision Damage Automobile Insurance Arbitration Rules administered by the American Arbitration Association. INSURANCE COMPANY: City of St. Paul Shaii Moore 15 Kellogg Blvd. West St. Pau1,iVIl�T 55102 PgorrE: 877-224-2641 POLICY#: Self Insured C�IM#: Unknown to Petitioner - POLICYAOLDER: City of St. Paul ACCIDENT DATE: 1/9/10 NAME(S�OF CLAIMANT(S� MINOR TOTAL AMOUNT CLAIMED Craig Johnson N 9 200.00 HEARING LOCALE REQUESTED: Twin Cities, Minnesota - I AFFIRM THAT TAE INFORMATION AND AMOUNT CLAIMED CONTAINED HEREIN IS TRUE TO TFIE BE5T OF MY KNOWLEDGE. Dated: � � �� Signed: (Must be sig by ClaimanUfiling party,or Claimant's representative) NAME OF FILING PARTY: Craig Johnson � 179 N. McKnight Rd.,Apt 112 St. Paul, MN 55119 PHONE: 651-354-2344 IF AN ATI'ORNEY WII,L BE REPRESENTINGYOU,PLEASE COMPLETE ITEMS BELOW: - ATTORNEY: John D. Scott, 0270635 Bennerotte&Associates,P.A. PxortE: (651)203-5990 3340 Sherman Court Suite 100 F,�c: (651)288-0860 - Eagan, MN 55121 ONLINE FILING DEMAND FOR ARBITRATION/MEDIATION FORM This conciudes your filing. Thank you for submitting your claim to the AAA. Your claim confirmation number is: 002-P8P-RP7 To institute proceedings, please send a copy of this form and the Arbitration Agreement to the opposing party. Your dispute has been filed in accordance with: Minnesota No-Fault Arbitration Rules This claim has been filed for. Arbitration Filing Fee: $45.00 Additional Claim Information Fee Plan: Claim Amount: $9,200.00 Claim Description: See Attached Arbitration Clause: See Attached Hearing Locale Requested: Twin Cities,MN Contract Date: Number of Neutrals: 1 Claimant 1 Craig Johnson Type of Business: Unknown/Blank Demand Name: Craig Johnson Address: 179 North Mcknight Road Apt 112 St.Paul,MN 55119 Telephone: 651-345-2344 Include in caption: Individual Representatives Name: John D. Scott Company Name: Bennerotte&Associates,PA Address: 3340 Sherman Court Suite 100 Eagan,MN 55121 Telephone: 651-203-5990 Fax: 651-288-0860 Email: john@bennerotte.com Respondent1 Shari Moore Type of Business: Municipality/Town/City/Township Name: Shari Moore Company Name: City of St.Paul Address: 15 Kellogg Blvd.West St.Paul,MN 55102 Teleph one: 651-266-6500 Fax: 651-266-8886 Include in caption: Company Insurance Claim Information Claim Number: Unknown Accident Date: 04/26/2011 Accident City: St.Paul Accident State: MN Discussed With: null null Polic Number Polic Holder Holder T e Individual Limit Multi le Limit Self Insured City of St.Paul Company To institute proceedings, please send a copy of this form and the Arbitration Agreement to the opposing party. Your demand/submission for arbitration/mediation has been received on 03/09/2012 16:03 EST. i ITEMIZATION OF CLAIM Criag Johnson,Sr. and City of St. Paul Date of Loss: 04/26/2011 REPLACEMENT SERVICE OUTSTANDING . Replacement Services (4/26/11-3/10/12) $9,200.00 Total Outstanding Replacement Services: $9,200.00 TOTAL NO-FAULT CLAIM: $9,200.00 NOTE: Any claims listed on Claimant's initial filing will not be updated at the time of any subsequent amendments. Rather, the total claim will be updated at the time of the Arbitration hearing, and will also include interest and costs at that time. PRIMARYFIOMEMAI�RWEEKI.YCA[.COLA710N5 OC(ObC[1�201� 21 100% $210.00 $200.00 Climt Ccaig Johnson Dete of Loss:04262011 Octoba B,2011 21 1009: 5210.00 f200.00 Octoba I5,2D11 21 IDO% 5210.00 5200.00 Calculatioa:(Pre-MVA Hours'S]OM"%�mablc to do pa wxk as a result of MVA) pctober 22,2011 21 100'/ 5210.00 5200.00 WEEKINDING PRE-MVA %IINABLE 'IOiAI. OWEDBYN£ Ottobcr29,2011 21 100°/. $210.00 5200.00 HOURS (M�5200/wk) Novemba 5,2011 21 100°/. 5230.00 5200.00 April 30,2011 21 100'� $210.00 5200.00 Novrmbc 12,2011 21 100% 5210.00 T200.00 May 7,2011 21 100% 5210.00 5200.00 � Novemba 19,2011 21 100% 5210.00 5200.00 May 14,?AI1 21 100'/ 5210.00 5200.00 Novemba 26,2011 27 100% 5210.00 I200.00 j i May 21,2011 21 700% 5210.00 5200.00 December 3,2�ll 21 100% 5210.00 5200.00 � naay2s,zoli zi �oa� sz�o.00 szoo.00 n�naio,zo�i 2i �oar s2�o.00 szoo.00 ]we 4,2011 21 100°/. 5210.00 5200.00 December 17,2011 27 100% 5210.00 $200.OD Juce I1.2011 21 100'/. 5210.00 5200.00 Decunber 24,2011 21 ]00'� 5270.00 5200.00 Jwe]8,2011 21 ]00% E210.00 $200.00 Decemba 31,2011 21 100°/ $210.00 $200.00 7we25,2011 2] 300'/. 5210.00 5200.00 Januery7.2012 21 ]00'/ 5210.00 5200.00 July 2,2011 21 100Y 5210.00 $200.00 ]anuary 14,2012 21 100'� 5210.00 5200.00 Iuly 9.20ll 21 1� 5210.00 5200.00 Januery 21,2012 21 100'/. 5210.00 5200.00 Tuly 16,2011 21 1 D09L 5210.00 5200.00 Jmuery 28,2012 21 l OD°/. 5210.00 5200.00 Jdy23.2011 21 100% 52I0.00 5200.00 Febniery4>?Al2 21 10� E210.00 5200.00 JWy 30,2011 2I l� T210.00 S200.CA Februery 1t,2012 21 100°h 5210.00 5200.00 August 6,20ll 21 l00°h 5210.00 5200.00 February I6,2012 2l 100% 5210.00 5200.00 August 13,2011 21 100% E210.00 T200.00 Febcuery 25,2012 21 ]00'� SZ10.00 f200.00 Augus[20,2011 21 100% 5210.00 azoo.00 Mffich 3,2012 21 100% 5210.00 5200.00 August 27,2011 21 100'/o E210.00 5200.00 Meich l0,2012 21 ]00'/o 5210.00 5200.00 i Scp[ember 3,2011 21 100'/o 5210.00 S20D.00 7'O'fAL 59,200.00 s��s�io,zoit zi ioai Szio.00 szoo.00 s�c�nvi�,zoii zi ioo^r szio.00 a�oo.00 Sept�ba2a,2011 21 100'/ 5210.00 E200.00 Craig Johnson,Sr. Craig Johnson,Sr. Intereat Calculationa Interest Galculations Date of Loss: 04/26N 1 Date of Loss: 0426N 1 Date of Cutoft Date of Cutoff: Date Fled/Amended: 03I09/12 Date Filed/Amended: 03/09/12 Calculation Date: Calculation Date: RePlacemeM Services RePlacement Services Week Endino Ewensa Pavmen� Unoaid I Week Endina Ezcense Pavmenfs Unnaid oaison� szoo.00 so.00 azoo.00 ovoai�z szoo.00 $o.00 szoo.00 osio�ni a2oo.00 so.00 5200.00 ov�vi2 S2oo.00 So.00 S2oo.o0 osi,an, azoo.00 so.00 s2oo.o0 ov,snz ;zoo.00 $o.o0 5200.00 osizin� szoo.00 50.0o gzoo.00 ozrzenz Szoo.00 So.00 szoo.00 05/28111 5200.00 So.DO S2o0.00 03103N2 E200.o0 $o.o0 5200.00 osiaan� s2oo.00 So.00 s2oo.o0 o��aiz Ezoo.00 go.00 S2oo.o0 Os/11/t 1 E200.00 So.00 S2ao.00 osnan� 5200.0o su.00 Szoo.00 TOTAL Ss,2oo.0o go.00 Ss,zoo.00 osnsni azoo.00 so.00 azoo.00 07/02111 y200.OD $0.00 5200.OD Pavments o7/os/17 5200.00 SO.DO E20o.o0 o7f18l11 E200.00 50.00 S20o.00 0723/11 5200.00 50.00 5200.00 o7i3oni S2oo.00 So.00 E2oo.o0 o8/O6/1'I E200.00 50.00 EZOO.00 08l'13/'11 E200.00 $0.00 $200.OD OB/20111 3200.00 $0-00 E200.00 oerz�n, szoo.00 50.0o a2oo.o0 09/03/11 $20D.D0 $O.DO $200.00 09/10711 $200.00 5�.00 5200-00 09/17111 $200.00 $0.00 E200.00 09/24l11 $200.00 $0.00 E200.00 10/01l11 $200.00 $O.DO j200.00 �oroani s2oo.00 So.00 E2oo.o0 �onsn� Ezoo.oa So.oa y2oo.ao �orzv�t S2oo.00 So.00 E2oo.o0 iorzsn� 3200.0o so.00 t2oo.o0 ivosn� gzoo.00 $o.00 gzoo.00 iv�vi� Ezoo.00 So.00 izoo.00 t'I/19/71 5200.00 E0.00 j200.00 i 11/26/t 1 $200.00 $0.00 E200.00 12/03/71 $200.D0 $D.00 s200.00 � tv1a11 5200.00 So.00 Sz00.00 �4 ivi�ni azoo.00 so.00 szoo.00 'IZrza/1� Ezoo.00 So.00 s2oo.o0 12/31117 5200.00 50.00 5200.00 o�ro�nz azoo.00 So.00 Szoo.00 oviai2 Szoo.00 so.00 S2oo.o0 o�rz�n2 szoo.00 So.00 Ezoo.00 oirzs��2 s2oo.o0 $o.00 szoo.00 Pege 1 of 2 Page 2 M 2 . 7oLason,�g A(t.�IIt#90201090)DOB:3/19l1970 Page 1 of 5 ; . Nmne: Craig Johosoq Sr. HODSFBOID SERVICES ED Provider Notes t. MaLs: 10 hours ED Provitler Notes dgnsE by GrNOn,Ca�he�ine G at OO2fiN1 1158 I.5 �dmmingofmmis quthor, Cerlea�,CatherineG Servire: (none) AuNarType:RESIDENT �_�ar�yqyoppmg Fletl: 0028�111t5B Nole 0 7/28/11 11 3 9 6 coo6ing&.Mting Tme: _aating teble TOTALg 21 hotus Trauma Team Aetivatlon Note: d�table Mle:<262011 1_5 d�ingdic6cs iinw:ll_38Mt EDAtlentli�q:Cfurcry 2. HouseM]d Qeming: 2 7wurs TACS AltsMing:Barmett i ��mg CC:Cngh Irquy �T�B �fl� HPI:Pa6ent k e 41 y/o M who prexMS to emeigenry OepaNnent vfe mEWks Wp aush injury.Pelknt _ w'+S�S w�� RLErtar�idrylaexNSr�bad�.��L�ast�a0a 0 W AM(h�ottlogLl��aW hclbe o�s��Nmovma b��ao pein n LuE. _wesLiugroilen � _wcc6ing s6owe�s&batlwbs PREHOSPRAL INiERVENiIONS:N aaesa(18G RUE�,N fluld resusdla0on,ozypen Wministralion.No � medicatlom ghren P��sP�� . 3. [Lild C�c N/A P�:� _d�esm8 yaNing j MEDS:Denies _�hanpjnB daPvs ��riar ALLERGIES:NKDA _nmsing�nediml cme SoHXIFMKK RtOS:Not obtained xrandary lo u�gerit nature of the patleM's emergenry room visit _o�izings�hoota�.eomm�miry�aaati�s _4nuponio8child�atoeeiv¢ia EXAY: _dixipli�u� Ydal signc:Plaese see resusdlation flowsheel far full set of vifals. Pulse was in the 9tls. Bbod qessure was arourM 140's ryslafic. 4. Clothing: 9 6ou[s Afebrie and satlin0 ffi 700%wAh 02 Dy NRB wBh a RR of 20. s6oppmp/queheriug clothug for frmily ��e�ry, Primary Surny: _m��B.T��B&x�8 Atrway:pl comer�M and profxtln9 aiway Brealhing:equW BS bihtxaly,?Oecreased&S R chest Cuculalim:central aW V�P�'+�7�Pre%e�t slun warm.we6ysAuseA 5. Iswn&Gmdm: N/A Diea Wiry:maei�p a9<eatramiHes aiM idbxinp mmmends;GCS-13:MaAOr&6.Ve'WI M5.Eye 3/4. mvwi�g ..Expesue:eN efeN�in9��neved.•Petienkiq�reNed.-V/eeF MnValwmdart. _.. -t�� Dbvbus mJuries to LUE end RLE,mnWsim rafed to R flank -D�"'��B � SernMary Survey: wxding HEAD:Abreslon wllh smatl laceratlon nded to R temple wetaing EYES:Pupils 3 mm eQUal end equey reacUve _ ��8 EARS:TMS peery wiN m hertatympmium NOSE�w dood in r�aec MOUTH:no broken kaN mandble eM ma:lAa grassly staWe 6. Traasporta�ion NECk Ccdlar not in place diiving CHES7:Heart repWar.W rgs cbar. _wndrinB vehielrs BACK La�9e m�eion R IIaNc Lapine ni0frie tantlemeas b palpation I, routiere vehide repeir&meintenance ABDOMEN:SoR obese end narteMer ' PELVIS:+sfable on AP and lateral Cmp�esdm _sno�i�mi.ew.y�ww�wan IXTREMfTIES:LUE amWlatla�luR Wmn�ul b wn9.Grwc defmriity of RLE rih siwherti�9.�a�Y mWed.ThreaOY PT puke In LL�bolh feet waim � ��q. GENITOURINAftY:m lacerations a injuries seen on ihe perineum Redal emm xas irogetrve far dood, _ twmeorepemMnc�epairecmaimmance nonrelsphindertone. �' � JoLnsoq Cceig A(MR#90201{190)PriNed by(5160)at?J77/12 11:59 AM Johnsoq C�aig A(hflt#90201090)DOB:3/19/1970 Page 2 of 5 Jo��q�g A�#9p201090)DOB:3/19/1970 Page 3 of 5 Vyg. p55E55MENT:41 yb M with LUE amputa6a+and L1E��jury wiTh bss d p�laes slp aush injury .. nml �:� 262011;'.�. ��Laksf Rel Rng� PLAN:Inpatiant hospital edmission b TACS. C ]3(H) ; ��4 0 11.OWul: - D�s: BC -,92 1.Crush Injury ��4.5-5.9 MNI :. 2 Amputaa�tbn LUE g'-'.'� _- '.4.9 CA7HERINEGCARLSON�MD - .f3:5•17.5�-� � � 1 �.�.410 530X�='-�:: �.... '- .3 � .� 1�� Ep ryotes igfrod by Ch g W G at WR7I71 7746 _ CH 2 �_�.3� AWhor. Chung,Won G Service Eme�9ency AuthorType:HP PHYSICIAN CHC ��'S.1 � ��t ��32-36 �� FNed: 04127/711746 Nole W28�171142 OW .3.3 7ure: . '11.5•11.5%:�. I �� . . m�s 1 ��Lt50 �SOk/ui��..-:: ��YaW4n�entAtlH tl'n�gSUW�ionNote PV Q7(H)':'.': . -.`'fi3 1001I �- ROTIME 3 0 I pe�Tametl the kry'ekrrents of his�Y and esem.antl apree wIM ieddenCa Md'ngs arM Plan of are as � �'120-71:5 aei��':: dieaisceE WM Dr.Peler Bapgens�a. . NR 0 �ryave rwlewed and agreeC wMh tlie PMH.FH,SOC,ROS. I e �.7T 32(L>'-:.:-�- Please see tedaYs note M resida�rt PhYscian. 21 0-37.0 sec- AssessmsnF. S/p cush by carwith L hend amputatlon.Also with R Toot decmau in pulse. 4na9ing: CXR-Cardiomediastl�l cantour is prorNnenl Wceh'reflectin9 AP supine bchrWue.If ihere's paaLSteN ciNral Plan: Ur metl"rasU�l iiryury.rmsdet rep0at PA upigM chast teCiograp�ar CT C11M far iuNM�as�rtient ��pix AbnMor given histwy of trauma.Low lunp vdumas wMh wme wanenirg of the mterstltlal marltirips No toral infi�trale. Re-chedc Vhels Riyhf lateiel lung beae i�ezGUtleE anE eamwt he assessed. ConaWtatbn:Hend Suigery andTACS Swgery N Fluitl XR PeNia-Mode,am s�od wm��me�ecam and aslal sis�caon xo aeGine�reaure«asa am�.e�om ca,nsN Pane�uramay performed on trauma Coard im16n8 fire 6one Eela& Re-avaluale peberR Check responx fo 6ea6neM ��p�. Plannetl D'spoeiEOn:InpeMent etlmlssian Pt was rtat M the emei9a�'rr�eE'idne snd 6awna suipery teart�s on m arrival.The WtieM waa transierted I waa PreseM ror key P��n of InWbetim /rorn saemier�nea ueine fun spmd prenwona Prhnvv ena.emnaar su�wn�re preformea es aemiba h�y�naea�aene review m me imaa�e�d'�ra�es err�n plxe. abo�re.ce�aec mmu«ane suaWa��re�+aaa��rvs esmaenea.naoa samaks sem.�d M e� NS�mbd far O ire8elNe doad. Cr16W Ceie AAdenEUm Obteina0 Portebb cheN x-ray entl PeMs z-taY as weA ss a FAST e�am FAST exam was nega6ve fir a�ry My iniliel assessment baceA m my review of P�ehosPitel Pirnridar raport review d nursinp observetlons, gmss intra-ebtlomirel or pericerAmllWid.Porlede C%R wilh�awhs as aEOUe.Pdtabb PeNls Xny wss revkw of vMel sip�s.focuseE hfs�uf'.MYs�ml emm aM tliscussbn with TACS.es�blisheC tlmt Gsig bhmo� ,�epae�ror awce nom�rvn.ai a�ar awo b oR W��nwweea w asi.smde um�me rerei w�enc nas ce.ae taumaec m�un's and wro mredenmy sa�em�.wn��mn�e,mrvennm,.,d wac seiA antl fhe Patientwas 6ar�a�tl to�idoYY br the bAowUi9 imapYi6 sW6ec CT Fiead�CT Ccpkie. thnelore he is aitiray 1L CT Chest,CT ABDIPeMC Recors oi t�e T 8 L spines were tlone as pa6nK df7 have mi�ne bedc pem and mediarosm�vss m�emin9 for cd�fracWres.FeMmY�end versed grven iw paln.Temnus was uptla�d. After the inilial assesvnenL the ce�e team initiafed muPoDb leb tmts�Ga��edvenced airray mana8ement anA mnwMO wph hand antl TACS fo D�viEe afabtcaBOn ca�Dua to Ihe oritiral naWro of Nis patbnt,l spa�wBn or.nnderaon win,amo wno d+�b mme see patleM.concarn ar poaieeal ee np,ry.vasamr reassessea v1m�sigm�Wryskai exmn and rapirainy s1eNS muRipla mres w�m na 6avosi0m. peged.Spoke wilh vaeo6ar et 11:de AM and appredab assistance wlih Mls pelierK Vea�Aer cann9 lo see P��Y�9t+e�as per orlhNplastlrs racs. Tirre alw spent P�rtNnB tlocvmenlaUon.reWevm9 ksl resull5�dkwssbn wIM cansulmMS end caoN&ialion = oF care tab and RWIOpaPhk ResWb:aee EPIC for C�C Cnliml pre dre(ettiWuq poceEUre6):40 minules. bhnsoq(�aig A(MIL#90201090)Printed by(5160)aR 7117/12(1:59 AM Johnsoq Cnig A(h4t#90201090)Pm�ted by(5160)M?117/12 11:59 AM � Johnson,�g A(MIt#90201090)DOB:3/19/1970 Pege 4 of 5 )oy�q(}mg A(hfft S 90201090)DOB:3/19/1970 Page 5 of 5 Date&time of last eWd 5/24 10D0 � AddHionallnformstlon AWnr Won G Chung,MD INGSION CARE Care of tl+e Indsion:keep cleen dry,irAacL(o9ow MD ordeis for dressing changes SPLINT CARE Fo6owihe MxapisYs instrudions forwearing the cplir�s. ED Provlder Natas signed bY Ba99�a Pefer A�t OIfl6Mi 1144 CF18ck tlle 61dn when�alon9 oR and pul4ng a1 sp�inls. AWror Ba99e^sfos.Pater A Service: (none) Auttwr Type:RESIDENT Da'gar sipns:watch for anY akin d�anpes Fke redness�rash�a break[bvm.GO tlie dodor if fha File�L W26/111144 Nale - 042BJ111143 spirds cauaessldn ehanges.' i T�: ValwWeslAAedicatlons I Disposdion ot Mo^ey(not recorde� HP REGIONS SPECW.TY CL61105. ; Disp0.silion of MBdiqdofl6:(not reWrde� 6rtu6e1wn Proceaure Note i Patier�t andlor famity verifbd Mat atl valuades have been ratumed:Yas Patierrt andlor tamiy verified thet all valuades removed from room safe:Yes �ate of Service:(ro[remMetl) Immunfation Doeumentatlon Universal Pmtocol:Pracetlwe Laation:ER,Conditlon'Elediee.Consent(not'ewitled).Palient IOerfifirafia^: �re�dpcurt�entat�In yx Irmmun¢atioMnjeUion sacGon endla Me AAAR(NOT in Me notes)that Verlfied,Tlme OW:Performad,Protective Barriers:Eye Piotedion;H�hirg:Gbves pie patient Ainray:Pre-InWbatlon:(not remrtled),Tube Placerneirt(nol racudedl.Intu6�im Asdst ElT Introducer (6ougie):Cnmid Pie�sure.A�Required:2,ETT Stre:8.0 C�dFed,ETT DeNh:73.PlaromeM Pneumonia:refused ihe pneumococcal vacdne. �rmation:Bilataal Br�ih SouM�Symmetric Bream Sountla:NO b�tl�sounda ouv stomech. Influenza:did not receive the influenza(ceasonal flu)vacdre bepuse H is nd flu season. Cwnpicatfons:None � Uamers SWns MeAicatlms:Topiwl Medustions:None,IndudioNParay6c MeEiratbns:None;SUCdnykhoGne;EtomiEate, Monkor patleM for.chest pain Atldilbnal Canment(not reoordeE) dilficutty breathing PerfomieA BylSUpervisim Inkrmatlac Perfortntd ey:I pertormed the eDwe pmrbAure m�sett,Atlentling (ever greafer Man 101.5 deprees F $te�emeM:(nDt IBCD�tle� pain not rclieved writh usual methods Peter A Bapgm�sto6.MD ShoMeae af bfeaUl � SIGNS OF WOUND INFECTION:drainage from wouM,redness or sheak(s)from wourM, _��_ ncreasing sorenesa eround wou�d and fever greater than 101.5 dagraes FarenheigM Nursirg unN phone number.Rli C51,Rh C51 640 Jackson Street • SL Paul,MN 55101 All Othar Provitler Notes Dept 651•254-0053 � 7ransaibed Documents lfor vivts orior to Mav 1.20641 Loc:651•254-1234 All medical devicec(telemetrylN/etc)unlass otheiwise ordered,have been removed betore asa,��. ED Comorehensive Raoort Smolting and secondatand smoka exposun: Smoking damagea dood veaseis,reduces the oxypen in the dood and may meke the heart bea[too Fbwshwm fast It the paUeM smokes,educate and encounge him to quiG Everyone s1wWd awid eacoM-hand - � cmoke.M tl�e patierd would lice tuMer assisfance,piease corrtact 1�77-2765TOP w have him visit F�� www healtlioaMars.com arW Perfners in Quilting ran ofief(urther infolmafinn antl essistence. Dischargelnstructlons � �iscMrga Imtructions �ISCHARCaE INFORAIATION FROM NURSING � SeHGrelrrtormatbn ' PRIMARY LANGUAGE:Erglish WEAKNE55:boN legs. AMPUTATION:below the albow left arm. SKIN:Dressing tlanges fo RIE,zeroform,keAec,acewnp.No open areas m badc or buftod�. , ' MENTAL STATUS:alert � � SELF CARE STATUS:Independent in e%adivities ot dally frving except BATHING:needs help � washing bedc and R sidellags DRESSING:neede assist M 1 persoNpeople , TRANSFERS;requires total assist BLADDER CARE:Able to control dadder. BOVJEL CARE Able to mntrol bowels Uses a be�an wlth assislance. - Jo6asoq Cmig A(MIL#90?A7090)Peinted by(5160)ffi)l17/12 11:59 AM Johnson,(.}aig A(MR N 90201090)PrinteA by(5160)at 2/17/12 11:59 AM 7oFmson,�Yaig q(MIL#90201090)DOB:3/19/1970 Pege 1 of 6 Johasoq C�aig A(MIL#90201090)I)OB:3/19/1970 Page 2 of 6 SN7H t:rpM fasdofw�ry sile IdD aM dosure. Diseharge Summary 5l78111:Left knee swpe with pos�mo�ataral wmer rewnstruc6on using alloproft entl intrearficuler D/L Su 's s'gnsd by bhnsw�Lind �,�osna»oszs tlebridemenL AWnr: Johnson�LirMS L Service: Sw9�Y TACS AuMn Type:PHYSICIAN ASSISTANT Co�aruMS: FileC: U52M17 0926 Note 05/17/'I1 0747 prthopaedic Surge7(bdh 9raups et Repio�) T�"�: Plastic Surgery ise�no-r asydi�any:ce��zo iro daay.wy�errt r�inaMa�osychou�eraPy. REGIONS HOSPRAL HPI:41 yf dd male was pinned beNreen his wdk trutle and anotMr vehide.Had oWiws amputalion to tha TACS D'scNrge Summary(�) Le11 upper ect a�W ngM bp delormity.Unlmovm loss of wnsdouwiess.Unkrpwn tere oT aztradbn.%artNed al Ihe ED epeeldng wilh a GCS ot 13.hie was IatliYpbk and haA 1 bag M aystelloid hanginp.Patient qscharge Diapnocie: tnchycar6c in FD.GMsn 3uNh of O nag whik in ED arM CT uamer.PaEeM wilh abvbus mrqbte ampulaow,�en raearm Rgm�eg mmaenments nard,slryicer ot anm;ar mmpermrnt M«mo wnne tn ct En ounter Diagnoses _ ._ sran o1 upper 70's.Pt acannetl antl taken emerge�tly W the OR for fasriolomy d rigM bwer lep,plane films to Cotle' ...Name '. ' "... _- � Primay?,.'. DecomWekdinOR. � • 309 811(� PTSD(post-0'aumatic strnss dLswtle�) Y� • 887.0 AmPut babw elb.unYat Injuries� • s1e.e1 nw�respMartaiWm LN[torea�mhaum.ECCOmple�eampumtiw, - 92e.S Ciusldn8�1�Y of u�upecif�etl aite W lawer Gmb �2iM�tloseE radius hxWre • 338.17 Aane pan Oue to trauma iign[cbced MtlAk phalaruc and dWai D�Isiuc haclure • 285.1 Aane pmMenwrthaeic enertia �tigM brer e�d wmpeMient syndmme • E819.3 Place of occurtence,inCustriel da�s aM premiaea -sPlank coMUaion • E814.7 Mohx vehide co9ision wiN D��.m1�9 P�� -P�sible renal conWaion vs previous inkGion • 928.8 Qushin9 M��Y�� +i�t posbrbr comminWW seval Be�re • 728.88 RlrebtlortHdyais +�Bh�Ltial G��hamrte •453.40J OeeP vein thmmbosa +i9M Ibu W Iwatl aM neck UaWre • 687.4 Artputat arm.unil� �e115tt�tce prodmal phslanx fracW�e •453.�0 Ac DVT/uribl bw ezl NOS defl 41h ice mitltlle Melanz haUUre • 785.0 UraPecified tachYCmd"w Le1!avulaion Yqury d Ia0erel matledus(tikeN old iyury) f • 799.02K M'OOVa JeR laEenllemoral corMyk avulam ireclure arM f�ular h aA avulsion Gac7ure aelf W�ee injuries: I • 799.02 Hypo�mu • • 958.92C ComPeMn�LL syndrome of bwer extremilY.trwmatic -Paftiel ACL b� � • 823.00U Tmiel plafeeu haclure -spain vs pnrEd Mar ot MCL • B65.00F Spken injury 3ntrasubslena�ar d PCl • 958.92 Troumetic comPaM�ant eynd�mie of bwer exVemity -MeCial manieac tmr - 823.DU Cbced fracWre of upper end of tibm -I�eral mmows t�r • 865.00 U�pedfietl sA�igury witfaut menCm U open wound iMO cavRY -med�ial xM lebal relatively norvdlsplacetl tlbial plateau hacWre • 3o7.eAD Agi�ation fidiar head 6awre at t�serlion M posimcr lalxd mmer shuWres. • 307.9 Spedel symplom NEClNOS • 518.5 PWrtanary insulfiden�y h6owhp lleuma and surgery • 599.OAH Eacherichie wti winary tratl Infec�m HosP�course: •276.6BA Hypervok'Ma PaderR was�ken Brrergmtly b Uie OR for�'olnmy.as-fa b ripM brer e#g'rven his Imee tliabcalion.entl I • 599.0 Urinery hact infection,eke not specified 18D of fhe IeR upper extrerMy.Mr..bhimon was atlmiLLeO b Ihe SICU ac he wat inNbeted.iN pryeE in tlx i -276.69 OMer Bud owroaC SICU thmugh SHDH 7 hav�g muXipie operationc licqd abwe snA prolonped xeanirg regirt�hom iMUbstlon, • 309.81 Poalhaumemc sVess diaorder attaetl��steWS,Ufi,aM wau�W inlectlon.Plearo see bamNr�fiom 511d11 q Fnnda BentanM fur : fuMer tlehls regartl'nq Mr..bhnaon's SICU sley.He�ras harisferte0 b Ihe Toor�shhie contlitlon.He IuE , no[resD��'w ortlisc icsuea.He was sUMd on an SSRI given depeasive syrtptortis and peyU�was Admiccbn Date:U26H1 consulkC M flashbacks 8tM PTSD symptoms and hs was sLrbA on poprandoL CuMurec from tlie right loxer Dist3�erge Defe:523�11 ��^H 8�'nre VRE aM pt was slarteE m enpitiloi.repeal o�grow A eaimbNi antl abrz aWtriieE to imasYn.7h1ui9�tlia P�P�K was efe6rie to mM ropesent lovl inkcfion a mNartiretim.Given Proe.eurec: NfecOOn ri�k N conEnued b go m Me OR tor 16Ok of t�e rigM hsddony sIR antl n wss WMieOey doxd m � 42N17:RlF Fastiotcmy,R Imee ex-fa,bit bre�nn 18D. 5�17/11.IMra-operative aMuies were nepaUve hom WtioAOny We ao his aEz we�e dk'sd s�d M remalned 42fl�7 t:R dosed ieduqion mitldle antl E�fal brp fitgxfiaCUre.ORIF iiyht raOius hecWre.ISD LUE wiN afebNe.The foMrvN daY hB went(or igsmenmuc iaWn of hic kfl W�ee whitli tie�olentetl wall.Post waunO VAC plecement ope�afivdy ne had atld'Aional Pal^F tl�e lell W�ee and Hc AauQitl w s Naeaxd,he wsa trauXiaietl b 429/11:R19ht fesdotomy ske IdD end VAC chatpe meCiatlone wdh 9�0�raief�He was accepletl bf tanakr to Capital Vlew TYXJ on 523I71 aM rvas 511M 1:STSG fo kR arm antl 5'f5G to ripht leg.Delayed cbwre M right bwar ett tastio/omy allas.RigM ffiiel transimed on 52M11 platew ORIF. ' SH3J11:EUA of kR/aiee,RLE d2sring change � During hu day on the�bor he Wle�aled a diel wRMut diRwlly,had regulsr Oowel nqvemmla,end his pain 5/14/11:ripM faxbWrtry sne I&D end VAC d��t was well controlled.He wrked wMh phyeicel tl�erap�mitl omipalioml tliaaq and W6malely vras Aeemetl appmpriak for diccAarpe. JoLnsoA Ccai6 A(MR#90201090)P�inted by(S I60)at 7117/1212:15 PM IoLnson,Cmig A(M!t#90?A7090)Printed by(5160)sa 2/IJ/l2 12:15 PM Johnsoq(kvg A(MIt k 90201090)DOB:3/19/7 970 Pege 3 of 6 , Jolmso4�6 A�#�Z01090)DOB:3/19/1970 Pagc 4 of 6 Uicehup�Ecam: OBJECi7VE: ' Patiant Vllal Sgns In the pssl24 hre: D'peharge PIu�Mnp: . 7� � P� � �p �2 �MM7� CurrentD'iscMrgeWtlWtion'List o5121H7 _ ' M ' ' ' ' STARTdId thnemadlutiwn _ 2215 OSR7l'M 98'F(�.7' Orel 61 120l67 18 9I Y. RA acM�mMophan NKA 1YLENOU 325 MG hbMt � . . . 2000 C) mmHg Tnke 2 Ta6s by moulA every 4 hourc as neeEed. OSl21H1 98.4'F(36.8 � 87 72Bf68 16 9B% RA Qly:ba Teb Ra1Hc 0 1600 °C) mmHg 0521H1 98.1'F(36.7 Oral 63 123Ti1 77 98% RA ctlaloPram(AKA CELFXA120 YG hM�t 7200 °C) mmHg Take 1 Tab lry moulh tlaUy for 30 Eeys. OS721H1 B7.5'F(36.4 � � 141/69 16 9B% RA �ty:30 Tab RefiYS:0 0800 °C) mmHp 05f21/11 98.1'F(36.7 � 61 127168 2d �,� � eno:aparin 80 MGIO.BIA�SOLl1 inj�clbn 0000 °C) mmHg Iryect 80 mp v�hartaneously evay 12 hours for 30 days. � Qly:48 mL ReNs:0 Gen:AO 3,NAD paEapentln(AKA NEURONTIN)�00 MG upnle Lungs:CTAB,rw rhNV Take 1 Gp 6y mWM Ih1ae tlmes a dey 1Dr 3D deys. CV:RRR ply:go Cap RefiMS:0 Abd:soR non-tentler,rwn�dictmded. �tr^�� melhedone(AKl1 DOLOPHINE)S YG bdN RUE:indabn U�.Shangth imprwing in R�E.Still lacks lull wpination antl pmrWim,intaC epNpYfinger e#, �, Tal�1 Tab by moutli every B Mitts. abtl/add fingers,prasp.SIL7 r/u/m nerves.Digits vrartn antl wUl perfuseE,cap refitl Qse�. ' py:90 Te�Refilis D W E:s/p ideartn artputaUOn-dry efabs.heaBrg we9 RLE:Dresaings d�,mota inled fil,no EHL/AT.SILT Tibial antl DP.No smsadon to SP.Di811s wartn and oxyCODONE(AKA ROIUGODONE)b FM immetliafa releesa faMet w��°S�.��Q� Take t-3 Tabs by mou[h every I�wrs ac neetletl for Pain. LLE:KI in place.Mota hitact ehVihl.SILT s/shydpft nerve.Digits wartn ana weA perluseQ cap refiA Q secs pty:�pp 7ab Rd�BS:0 V�: polyefhybne glyeol(AKA NIRALAX)packet Take 77 p by moulh deity iw 30 tlayc. Lab Rscults Oty:510 p RefiNS:0 ConSponent�_.'. . VaWe...._ _ _- Dalelfime� �_, BUN 72 . ... 520/11 06:10 AM -' p�pr+�wb�(AIG INDERAL)2G IAG taNM SODIUM 735 520111 06:10 AM Toke 1 Tab Ey moul�Nrae�im s a day Tor 30 days. SODIUM 743 ' 4(19/71 12:45 PM dly:90 TaC Refills D CREATININE 0.69 ' S20/110fi:t0AM K 3.8 � 5R0/if OE�70 A4 sanm(SENNA)Sb MG hblst K 3.6 � 4f19/17 12:45 PM � � Ta -�e fZTa�6�'inouR�-tuv finie+e Hay es�Qfir -- CHLORIDE e6 520/1106:10AM ��6�' CA2 37' S2N11 06:10 AM Oly:bU Teb Re(Ils:0 GLUCOSE 118 520�1106:t0AM CA 8.4 52N11 06:7o AM zolpWem�/�KA AIABIEN)5 MIG fabbt MG 2.1 5/16�11 11:07 AM Teke t-2 Tabs by imuth at bed6me as needeA br Sleep. PFI0.5 4.7' SHe/tt 11:07 AM Qy:3U Tffi Refills:0 Lab Recutts . Corrponant ' . Value.._- -.. ':'.�Da�rtie:�.'. _.. - WBC 10.8 �520/1106:70AM RBC 3.78' SI2N11 08:10 AM - HGB 11.5' S20/11 06:10 AM Dkchirge Procedwe Orde�s HCT 34.2' `�2N1106:t0AM OrthooaedlciS ortsMedlclrreRe/eml-AduWPeds MCV 90.3 52N11 06:70 AM Date:2 weel¢clp dixharge Txre:Pleaae sd�aduk PmviOer. MCH 30.4 5/1N71 06:10 AM Order Comman(r Dr.Ly. HeaMPmtriers Reyans Sperially CGnk:OMopaetlks; MCHC 33.7 520.�11 06:10 AM 651-254,830D;640 Jadtson SL SI Paul,MN 55101 RDW 14.7' S/LN11 06:10 AM Vaur povi0er�as iamnvnerMetl an eppoinhnent wilA PLTS 430 S2N1108:t0AM FIeaIMPaMersOrthopaed�cs.Youmayc�l&51-254A300.Option Johasoq Craig A(MR#90201090)Printed by(5160)at 7117/12 12:15 PM Johnso4 Gai6 A(MIt#90201090)PriNed by(5160)at?Jl7/12 12:7 5 PM JoLnson,Craig A(MIZ#90201090)DOB:3A 9/1970 Page 5 of 6 Sohnso4�8 A(MIt N 90201090)DOH:3/19l1970 Page 6 of 6 '', t fn schedule your appointrnent tt you prefer,a schedukr wlll head fractuie at inertion o/poslerbr lateral wrrier strucWres. I Scheduliig Instrudionx' contaG you witliin tl�e neM 3 business days lo assist you in setling up�his appoinimen[ AdmH to Sk//led Care � pNerSpe�ifi�Q�eyq� q�y+�e� Commenfs OrderCOmmenfs: FACILITV NAME TCU The patlenl sirould be aeen D��k�� py. PhvslW TMranvlPn Re/ernl Reason for vish7 Tibial plateau fx enE marry oMer O�Uer Cortxrenfs EVALUATE AND TREAT &Bu. o�u„o,em.�n�.��ion rrsa�.,i Plutica Suraerv RNertal-Ad H/Petls Ortler Convnents EVhLUNTE AND TREAT tt an appoiMment�h HeakhParhiers Plastic Surgery wes ativiaed e�M you tia�re�w1 oeen confacled ro srlietlWe Mat appoinurent PNasa nll M vou here westlons w'rfhin 3 business days,pl�x dl 952-967-7977 tor Tnume Unit(651)254-0053,Traume Nurse Cfiniaart(651)254- essistance.YOUr pmvider has remmmcded an aGPdnimerd wiM Order Comments: 3452. $CAB�UIIIIg IIIS�Nf1l0lIS ��pa�ers Plastic Surge7.You may tall 952-967-7977 W sc�eduk your appointrner2 If you pefer,a sd�etluler will contact WoundiDressino InsfrucNons you wilhin the ne#3 business days M assist you in setting up mis Order Sped(k Ouestion Answar Canments �PP��^� VYounO Meauert�wY 15 an tliameter kfl eim,MulM1ple k R��.��.�� Uu fasciotomy sYes Sdiedule-7�� Lxatlon of wouM LR�e1�t WaPs��e�lon ake. xeek(dbwiig tlisUarye. APPoiMment Uryenq'7 NorWrgmrt(within 4 weeks rn Diesahig xaobrm gaiae antl kerlez tlaiy Patierit 9rven�S) tM�en b Reavme Namal AWvMes: � Linda Johnaon.PA-C _ Order Canments' eou rrey resume narmal xtivlEas mce Yu�!dher rashiGionE ha+G ' nEetl. WNoht Bearina Resbiefions Non weight besrirg ail 4 eztremNes.Af1er th's yw may rrsume OrtlerCOmmenfs mmWwelgMbearingunlessY��P�'��g�YOu atltlkiorial resMCtbns. P/aese caN H vou Mve ouestiona OldelCortarwnfs.' Trauma UnR(651)254-0053,Treuma Nur6e pinitian:(&51)250- 3G52. D� OttkrCOmmenfs Regulartlietwittichocolahensure Ofher Dlxharoe MstruCNons tj Notify MD'dparsistent nausea,vortYtinO.��'B�'�01.5,w Wges ID wauntl(letlness.Pain.E�anegek)A ti'irtY OftleB:No �I � Ortfer Commenh' �'d^B��knee unitl tlearaE by Or.Coopar OMw.CPM b rgh[ �� b�ee 1 times dally xt at 0-05 dagreec.inv�se ROM pr Dr.Ly �� Ohho.ROM okaY for dlsterel�pper e�Okay ro 9d up to cl�ar. i � Keep PFO on rigM foot M prevml equ'viw. i �charve Dtaw�osls � . 1eR Wmarm traurtallc wnd��EOn-Ri7M Weed tadius I- fraduraright dweA miOtlle ptielanr erM�tal phalenx trarlue � Right lower ex[mrtpar6rie^t ryrdromeypknic co'rtusbrvpossibk renal contishn vc PR'�qus inkdionjighl0��camiinNed sacral fn�Lire-righ[tibiel pletew 4aWae+ght IlbWar Iro�f and ONer Commanfs' nede harArte�le115ih tae pruxenal plbl8nrt heduro-kR 4Mi l0e nitltlle phWenx/fHCW�9Le11 avWsion iyury of tate�el mBlbolus fGImN dtl tr�juryN�laleral kmoral mMyk aw6ion trocture and fiWlart�ee0awkionhecW�eaeftlmeemjwiae: -Parti�IACL tnr apan vs paNd tear of M0. tintrawbslarice�er of PCL �AMeI rtwniscus br -Ialerai meNSau tear+red'wl and lateral relative�Y norMiaPWcetl tlDial pshau fracGCe -I�Wm 7ohnsoq Claig A(MR Y 90201090)Printed by(5160)u 7I3�/1212:15 PM Johnsoq Cl�aig A(MIt k 90201090)Pci�d by(5160)at 2/17/12 12:15 PM � � B�xo�&Assocla�s,P.A. HdpingJnd_wlwi help b nrdeda%a."' Aa arL,��•»cwuida U�is letter es ma demm�d thal you yey the 57,000.00�WYable W o� office and Cnig at tivs tima la the m�ent tlmt we do ml lsar fian 7ou,we will Sk mbitmtion rom m�narre na�t�i�.wi� w��to M�Mesom sm�56sesss. cnriouromM if yrou heve my questione,plwe conba me 7Lenk yo¢. Vie weif aod Fxvwile �oxNSCarr shariMooro.CiryClerk YO1°s�'°S�r. �nea.a.maew b 310CitpHall Bre� & P I S Kello�Blvd Wst Saint Peul,MN 55102 &nsil:eityclvic(a)ci.aqmul.maus Fax:(651)7b6-8574 Jo6n D. Sandcn Bodmskiner Anomry Law Mma6wr-Wo�rn Compu�sation and Tmt Liebility ( 7DS/vn 25 Wect FwRh SL,Sta 200 i Cc:Clicnt Ciry Hnll Annex Seint Paul,MN 55102 Fus:(651)266fi490 � RE: NOTiC&OF N�-FAUf,T CiA1M;DEMAND POR PAYMBNT MYCIienC GigJohnvon�Sr. Our FileNo.: 14764 DPh Or�0J16}': 4/2(�� Maes Moole and Bodrnstciuer. Ou�office hsv wvttm W pou pmiwisiy cegarding our climl mig Johmon SY.R'e have mquccted informefion conaming e no•fauU daim for Mt.Jo6nsoq but we 6eve nol hmrd 6edc from you in this mgard Wo�icers'Comywation is iidvd prunsry inmiv,but Mnnceotallo-Feult Iaw provides covwge otbenefits fiet aro not peid foi,or ack¢owledged,by wakca' oompcasefiw�.speci6cauy w neig•s case.r.fuinesomNo-Fedt provids rzy�mmm: aen•ices 6enc5ta,in the amount of up to 5200.00 ner week,pmsuant b Mmn.Smt §65B.44.7'l�ece n�e ezpu�ncs ro mvu the urc aod me'v�wuna of a home.Sincc the Anlc of�Iw collisioq Caig]ms nuded ry�lecemart suvices ax defumd b��16e�atute and clariLe�by Minnewta nsn law.induding Rinhdahl�•.Nal'I F ners Union �� , lnsurona.373 N.W2d 294(Minn.198�. A6 SOLII�f�M Y11�11C Of fCP�BCC1oCL[Stl'VICES 1h8I�TI$}MS OCCdEf�IS��.0�pEI NCC�. Gom Ihe darc of f6e injury 1a the qumt Thae Lave bcen 35 aeeks s'v�ce t6e iqjury, and at E200.OD each week the cu�nt bwefit you owe C'g far t6ose�eplacemmt sriv�cev ia S7,OW.00. � 3390 Sha�mm Caurt,SuNc 100•P geq�.4!55121 PA:f.51-JA3-5990•FA7(:651-]96AH60•��mw.bainuollemm I I A1Vf�RICM ARBI1'RATTON ASSOCIATION � Craig John.wq Sr, I Claimaat, � v. NOTICE OF L�N FOR � ATTORNEY'S FEES PORSUANI TO MINN.STAT.§481.13 I Ciry of St Paul, Resfwndmt 1'O:Shmi Mooie,Ciry of St Paul,15 Kellogg Bk1 Wa4 St Psul,MN 55102. PLEASE TAKE NOIICE that ihe wde�si�ed has been rctaincd by t6e Cleimant ta mpxesmt said Claimant in ell mattas erising out of the ebovea�aptioned met�. Puesumt ro Mm.Smt§481.13,the und¢sigued does have a lim for enomry's fees �evulting from the reprexentation of the above nnma Cleimmt in tLis procading. Respectfully submitted. Deted: lolm D.Scott#0270635 Attornry for Claimant 3340 Sheemen CouR,Suite 100 Fa�a^MN 55121 (651)203-5990