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Coleman, James i�E��1��C� �(AR 1 f ?!11 NOTICE OF CLAIM FORM to the City of Saint Pauls�innesota �:��°� ��.��-��. Minnesota State Statute 466.05 states t/ua "...eve�ti persun...k hu r/aim.r dantciges from curv municipulit��...shci/l�nuse�u he presented to the governirig bod��of the m�ini�ipalin•x ithin 180 da�:r after the alleged los.c or irajur�•is discovered a notice stnting the time,place,and ci�-cumstances thereof,nnd the amount of compenscttion or other relief demcuided." Please complete this form in its entirety by clearly typing or printing your answer to each question. If more space is needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as much information 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 completed. If something does not apply,write`N/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102 First Name,��rv�e� Middle Initial � Last Name��,p�� Company or Business Name�� Are You an Insurance Company? Yes/� If Yes, Claim Number? Street Address �y � GY1c,�.f'�� F-tVei City S�"• �C�v� State �/� Zip Code� Daytime Phone�L)�� 5��3 Cell Phone(��,-.w�a.- Evening Telephone(��..�� Date of Accident/Injury or Date Discovered �� I o��I i�,�I� Time �SS am/� Please state, in detail, what occurred (happened),and why you are submitting a claim. Please indicate why or how you �I feel the City of Saint Paul or its employees are involved and/or responsible for your dama es. r ,l _tJo� " Ve � an 2�Z`t-IZ Q � �` � � 4 • '' � 0 V��Qi(�. �9/ � � � %ti p i S v r •!L � Go�,t7� (�_�-e�tt'i tvt� �_�►, � M �a. r sf'. Ple�a check the box(es)that most closely represent the reason for completing this form: Q"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 ❑ My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property ❑ Other type of property damage—please specify ❑ Other type of injury—please specify In order to process your claim vou need to include copies of all applicable 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 WILL NOT be returned and become the property of the City. You are encouraged to keep a copy for yourself before submitting your ciaim form. •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 are always welcome to document and support your clain�but will not be returned. 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—please complete this section Were there witnesses to the incident'? � No Unknown (circle) Provide their names, addresses and telephone numbers:�� o��c�er o.� �3-�n� as� 1�� c� �,�.e,�,k� Were the police or law enforcement called? � No Unknown (circle) If yes, what department or agency? �U�� Qa.t�..aw , s Case#or report# t�—(�y�-�g� Where did the accident or injuiy 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.� �- �c' �c�n c� p. Y�� va- �.n� VY��V r5'�-v rP Please indicate the amount you are seeking in compensation or what you would like the City to do ro resolve this claim to your satisfaction. Vehicle Claims— lease com lete this section ❑ check box if this section does not a 1 Your Vehicle: Year�_Make_1�._.��,.k Model � i License Plate Number (l�G- �{ l� State�_Color 'fo..in Registered Owner �1�1,(�14 Driver of Vehicle Area Damaged City Vehicle: Year " '�_Make Model 'S 5 r� U��-• License Plate Number ' State ��U Color i'�IN. 3�hlt�. Driver of Vehicle(City Employ e s Name) '�+w� ��►�� c�o�-�� "• Area Damaged �1�r�� 2n� L- e� � ' '�(�`{�v 1 S�5Z7 \`110 Injury Claims qlease complete this section L�check box if this section does not apply How were you injui-ed'? 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 Did you miss work as a result of your injury? Yes No When did you miss work? (provide date(s)) Name of you►�Employer: Address Telephone Check here if you are attaching more pages to this claim form. Number of additio al pages.�� By signing this form,yocc are stating that all information yoie have provided is true and correct to the best of your knowledge. Unsigned forms will not be proeessed. Si�bntitting a false clainz can restclt in prosecr�tion. Date form was completed ��,,�.��.t-�— Print the Name of the Person who Completed this Form: �O—'�� 1��, Signature of Person Making the Claim: � �^�� Revised February 201 1 Dear Sandra Bodensteiner, My name is James Coleman. I want to thank you for taking time to review my case. I do not know exactly how the claims process works and I'm hoping you can educate me. I also wanted to write you a letter to explain my claim, and include a bit about who I am. I have lived in St. Paul my entire life, and truly do love this city. I bought my first house in the Midway Neighborhood just last fall. I have been involved with the neighborhood for over ten years, starting in the local Boy Scout troop, where I received my Eagle Scout Award and I'm now an Assistant Scoutmaster with that same Troop. I am a member of the Midway Men's Club, and my mother was on the Hamline Midway Coalition for years. Like I said, I really do love this city. That is the main reason I am sending this letter in addition to the claim. I want to say, that I am not out to "get" the city. I know it was an accident, although a preventable one. All I am looking for is fair and proper compensation for my vehicle and personal property that was ruined as a result of the MVA with Officer McDonald. As I stated, I just bought a house a few months ago, and was planning on getting a rescue dog, probably a Labrador, at the end of this semester(you know, the whole house and a dog dream), and unfortunately that has to wait for a little while. I am also a college student with all the attendant college expenses. On top of a new mortgage, I now have to purchase a new vehicle (which was not in the budget for several more years). This is why I am asking for fair and proper compensation. According to the police report numbered 12-047-491, Officer McDonald ran a red light. Because of this I am now without a vehicle, and having to spend money I was not planning on having to spend yet. I am hoping you can help expedite the claims process so that I can replace my car and belongings as soon as possible. I myself am a city employee for Minneapolis, and actually hope to be a City of St. Paul employee some day, either as a Peace Officer or Firefighter. I would like to avoid any need to involve a lawyer, but I will use a lawyer if I have to, or feel that I have been slighted in any way. The last thing I want to do is get involved in any lengthy resolution of this claim. All I am looking for is the ability to purchase a new car (down- payment money) and money to replace the items damaged in the accident. Thank you again, Sandra. I know this is kind-of a lengthy letter, and I really do appreciate your taking time to read through it. Please, do not hesitate to call or email me if there are any issues, if you need and more information or clarification, ar anything at all. Sin erely, �-� �-�/�� - James Coleman * (651-230-5713) * JamesPeacel3@gmail.com 3/7/�2 Buick Century 1998-Car Standard Equipment-NADAguides.com Official Site I�A�A G U i p E S The Pow�r o#�V�hict� Irrforman�o� � C lose W indow NADAg�ides.corrs 3/7/2012 1998 Buick Century Sedan 4D Limited NADAguides.com Price Report Rough Average Clean Clean Trade-In Trade-In Trade-In Retail Base Price $775 $1,350 $1,825 $3,400 Mileage: 160,000 miles $50 $50 $50 $50 Options: I� Power Seat $50 $50 $50 $75 II Leather Seats $125 $125 $125 $150 � � Standard Equipment Standard Equipment Details Engine Specifications Type: Gas V6 Size: 3.1L/191 Horsepower: 160 @ 5200 RPM Torque: 185 @ 4000 RPM Drive Train Drive Train: Front Wheel Drive Transmission: 4 speed Automatic w/OD _ Safety Air Bag-Frontal-Driver Air Bag-Frontal-Passenger Brakes-ABS Brakes-Type-Front Disc/Rear Drum Child Safety Rear poor Locks • Daytime Running Lights Engine Immobilizer Headlights-Automatic Comfort & Convenience Air Conditioning-Auto Climate Control Air Conditioning-Front Air Conditioning-Multi-Zone Auto-Dimming Rearview Mirror Cruise Control Keyless Entry Max Seating Capacity: 6 Mirror(s)-Power Mirrors-Vanity-Driver Mirrors-Vanity-Driver Illumination Mirrors-Vanity-Passenger Mirrors-Vanity-Passenger Illumination Power Locks Reading Lamps-Front EXHIBIT Reading Lamps-Rear � Seat Trim-C loth � www.nadaguides.com/Cars/1998/Buick/Century-V6/Sedan-4D-Limited/Standard-EquipmenUPrint ��3 3/7/12 Buick Century 1998-Car Standard Equipment-NADAguides.com Official Site Seat Trim-Leather Seat-Power Driver Seat-Power Passenger Seats-Front Bench-Split Steering Wheel-Adjustable Steering Wheel-Audio Controls Steering Wheel-Leather Steering-Power Windows-Power Music & Entertainment Audio-AM/FM Stereo Audio-Cassette Player Audio-CD Player Interior Floor Mats Exterior Doors: 4 Mirror(s)-Heated Rear Window Defogger Roof-Generic-Sun/Moon Roof-Sun/Moon ' Wipers-Intermittent I Tires Front Tire Size: P205/70R15 Rear Tire Size: P205/70R15 Spare Tire Size: T125/70D15 Wheels Front Wheel Material: Steel Rear Wheel Material: Steei Back to top Rough Trade-In: $1,000 Rough Trade-in values reflect a vehicle in rough condition. Meaning a vehicle with significant mechanical defects requiring repairs in order to restore reasonable running condition. Paint, body and wheel surfaces have considerable damage to their finish, which may include dull or faded (oxidized) paint, small to medium size dents, frame damage, rust or obvious signs of previous repairs. Interior reflects above average wear with inoperable equipment, damaged or missing trim and heavily soiled /permanent imperfections on the headliner, carpet, and upholstery. Vehicle may have a branded title and un-true mileage. Vehicle will need substantial reconditioning and repair to be made ready for resale. Some existing issues may be difficult to restore. Because individual vehicle condition varies greatly, users of NADAguides.com may need to make independent adjustments for actual vehicle condition. Average Trade-In: $1,575 The Average Trade-In values on nadaguides.com are meant to reflect a vehicle in average condition. A vehicle that is mechanically sound but may require some repairs/servicing to pass all necessary inspections; Paint, body and wheel surfaces have moderate imperfections and an average finish and shine which can be improved with restorative repair; Interior reflects some soiling and wear in relation to vehicle age, with all equipment operable or requiring minimal effort to make operable; Clean title history; Vehicle will need a fair degree of reconditioning to be made ready for resale. Because individual vehicle condition varies greatly, users of nadaguides.com may need to make independent adjustments for actual vehicle condition. Clean Trade-In: $2,050 Clean Trade-In values reflect a vehicle in clean condition. This means a vehicle with no mechanical defects and passes all necessary inspections with ease. Paint, body and wheels have minor surface scratching with a high gloss finish and shine. Interior reflects minimal soiling and wear with all equipment in complete working order. Vehicle has a clean title history. Vehicle will need minimal reconditioning to be made ready for resale. Because individual vehicle condition varies greatly, users of NADAguides.com may need to make independent adjustments for actual vehicle condition. Clean Retail: $3,675 Clean Retail values refiect a vehicle in clean condition. This means a vehicle with no mechanical defects and passes all necessary inspections with ease. Paint, body and wheels have minor surface scratching with a high gloss finish and shine. Interior reflects minimal soiling and wear with all equipment in complete working order. Vehicle has a clean title history. Because individual vehicle condition varies greatly, users of NADAguides.com may need to make independent adju5tments for actual vehicle condition. Note: Vehicles with low mileage that are in exceptionally good condition and/or include a manufacturer certification can be worth a significantly higher value than the Clean Retail price shown. www.nadaguides.com/Cars/1998/Buick/Century-V6/Sedan-4D-Limited/Standard-EquipmenUPrint 2�3 3/7/12 Buick Century 1998-Car Standard Equipment-NADAguides.com Official Site The consumer values on NADAguides.com are based on the Consumer Edition of the NADA Official Used Car Guide� and should not be utilized for industry purposes. The consumer values may vary from the NADA Official Used Car Guidep values presented to you by insurance companies, banks, credit unions, government agencies and car dealers due to vehicle condition, regional market differences and frequency of updates. ADVERTISEMENT c0 Copyright Z012 National Appraisal Guides Inc. All Rights Reserved. www.nadaguides.com/Cars/1998/Buick/Century-V6/Sedan-4D-Limited/Standard-EquipmenUPrint 3/3 Metra - Wiring Harness for Most 1988-2005 GM Vehicles - IBR-WHGM2 Page 1 of 1 o�T Metra -Wiring Harness for Most 1988-2005 Our Price:$19.99 GM Vehicles Model:IBR�^✓HGM2 I SKU:9806574 � Be ihe first to write a review. . ��.'�:1 Shipping:Usually leaves our warehouse in 1 business day Estimate Arrival Time : Store Pickup: Check Stores � � £ � �-� -� � � -� � 1plpit l.earn about Sto�e Pickup Plus C/ Best Buy Cardholder Offers: I • Gel 4%back in Rewards:See How . 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EXHIBIT � a 8 http://www.bestbuy.com/site/Metra+-+Wiring+Harness+for+Most+1988-2005+GM+V ehicl... 3/7/2012 Kicker- Z-Series 2-Channel Amplifier Installation Kit - 09ZCK4 Page 1 of 1 �B� � Kicker-Z-Series2-ChannelAmplifier OurPrice:S149.99 Installation Kit � �� Mode1:05ZCK4 SKU:95�6�0� ��9I�� 3.7 of 5(3 reviews) ��I�� o,, i;�,r p Shlpping:Usually leaves our warehouse in 1 business day . 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Building upon the huge success and enormous output ; capabilities of the TC Enclosures, MTX has made them better.(Even we did not think it was possible.)Maintaining the side-firing ! super slot port design,these enclosures are able to produce more bass than any other enclosure in their class. Still constructed ' ; using the same high quality'/."MDF panels and dado/v-groove construction,TR enc�osures are as rock solid as the bass they delivec The improved cosmetic design,beveled corners,two different finishes(matte or gloss),and the addition of the MTX Audio ; gothic logo make these enclosures look as impressive as they sound.Available loaded with TR series subwoofers,MTX has a solution for anyone that wants an optimized solution that just hits HARD! reatures: i Specifications: Items Shipped: i "'nces ard s21e of nroducts offered on this site are limited to tre United States oniy. �'�REE shsppmq withm tr;e contiyuous United States unless otherwise iisted m2012 MTX�Audio,Mitek Corporation-All Rights Reserved.Privacy Policy�Site Terms&Co�ditions EXHIBIT � a �9 http://shop.mtx.com/p/1_97/MTX Audio_Thunder Round_Dual_10_2_Ohm Enclosure/list... 3/7/2012 ST PqUL IMPOUND LOT &30 BARGE CNANNEL RD SAINT PAUL� MN. 55107-2950 651-266-5642 Merchant ID: 8006380144 Term ID: 901739000089063$014408 Sale zzzzzzzzzzzz0662 � VISp Entrv Method; Saiped lotal; S 144,Z6 03i05i12 19;02.38 Inv a; 090006 Appr Code; 00585B Apprud; Online �ustomEr �oPY THANK YOU! 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II r � EXHIBIT � N � Accident Report Page 1 of 1 u� � I�t�� --- �ocx�vo. . . . r�ue�o ., -a� . ��+'�a+o'*s+� " O .. - • x i ,�s - A 12-0 4 7-4 91 N � �+ _ apc� �� oF ��--�=...r'r,�a: ° �'�� 3-�'� ��i'r ' ,� vE ur, ,�.r�. `� Mr-wuuRtA nRVaor vEwaES FuEn rul�o susi r apfy�rx�AUiyA . r ;�«n�rN J e� C _,rp f}�r�Ri {rR{ir� 2 29 20i2 23�[ m N N 62 00 O1 Y . o ROIIiESYS�EIA f2WiLMMBERORSTREETIMNE O .�y4YL`IFICiti,'. ❑M ^u E �� ` f! c ��NTEPSKTiON� OR _- _� a� 0 5 S M �C 4 W � rr �, 10 Universit Ave. �� 5,��„�„�,�,,,,,� ��Y� IMFLEM PFFERFMCE/OaT 62 ��TM 10 Hamline Ave. ,,,,P Saint Paul +—' �: _ , h .�,. _ _ s1�ie aASS asunn �,�5joai FOr2� vosmau ONNERLICEMSENUlPA�i S�TE OA45 asmrus aoa.w ow�RUC�+se�en-x MN D O1 �3 01 P046181501410 MN D O1 O1 T460273644010 o.reore�rR�+ rw�tna*.�+moie.usn o.�ovewr� racroR: =.croR: Nne.�iaRS.r.noaE,usn 0 4 0 3 9 0 33 DARIN THOMAS MCDONALD 06 02 71 ISAAC KANE COLEMAN Mv101. RESROCi� MO�+E% Owvtlt M5iMCT MNER �a �� N; O1 O1 Ol 367 Grove Street N O1 1470 Charles Ave. r�rvsa �� Gn��.� arv,sra�.zr+ 651-335-9903 O1 O1 ST PAUL 55104 6�1-291-1111 ST PAUL 55104 RCdX� /�WRE4C.� SEX SKEEOPT �E6]PT M'�OG E+E`T N19EV I10CPE53 3IX SAFEEGPT 5/�FEE�PT NPBM> EIEGf NISEV FLOSMIO O1 � M �vf 4 04 01 05 N CO�`T M "�4 "�09 O1 05 C O1 /.LLHL 1'VE ORIIG T'PE TOIqSi iR/JKGOIIT �M9t1lPNCf5E1Ni['F RtMM1�ER Kpt IYYE DRUG !YAE TONOSD 1PhM5�OQ� �MBUUNCESE0.VICE PIWMA�ER � 9B �s. 98 N Q�u '�f 9S {�" gg N: amEa St. Paul Fir 5493 �.._.- �......� : , _�..._ ,. . .Y.�.. ,_..._ . ,,.._-_ ., ,, ._,.,_- ., - FIHE � O'MMERMI�ME F�E .� ��v p��p QmER 14NE N O L p1 City of Saint Paul N - COLEMAN JAMES PEACE ,or�EO veM,rr ,rexrn �sa rowEO .nowss Y 01 O1 367 Grove Street Y 1400 ENGLEWOOD AVE vEHUSE ans+aEa �u.uK+ o4tEC� a*r.smlEZR rULUno aaECr vD��sE pg Saint Paul, Mn. 55101 '1V` 03 ST PAUL MN 55104 '"'t� 05 O1 �,a °'''�`°` ""`E "�` � �� UIC �CLM 998 TAN 04 O1 Ford C.V. 200 Blk Ol1G5EV RAIE} STREG vEMtFEG SE wMfEOF�S �MNYE�bI! RATEe STHEG vfMREO lE�MLlO^� � OMIA1 O��' 03 1931 Mn 012 O1 � �O1 RAC411 MN 12 O1 1 � x+SUPnNtE P0.�CVt+uYdEN wsw/J4Fl��Z1 POl1C�'NWSER Se1f Insured Allied Insurance IPPGM0033194477-0 CVNA YIFZ1.Ni WAIVFD MSYEZi101.M r�9VB�GE• WM'� MKfMT BM �,,�E �� IF ACClDENT INVOLVED A COMMERGULL MOTOR VEHICLE,SCHOOL BUS,OR MEAD$TART BI1$ q.+S TM� � - RENEMBER TO NOTlFV TliE STATE PATROL�repuirod undar MS 189.783 arM 769.45111. � Gp6YIEqON.VEMFIEMM61ER1-MOT�RUPR�EPNAIE OO�MIMBF.R GOUAQAC1ALVEW[IENWBER2-MD'fORCMN�ER�WeE �T��A PA.SSENC:�IW.TNE55E5 UreT VOSiNM�E0F9Rf 9EC TVPE USE M9�G EJECT WJSEV tOM09P�RI�MSNRT Q� AI.a9@NItE ��p � r Oo.�^ C . a„� iwasmv� � aun�a�x � �o�u �� n�4eknNCB IMAVwAeER ❑JTfR .....___.. ..__.._ .." '-.___ .. .. . ..... ..--,.�__ D�tlA('.EDPRMEw1Y/YELLOMLI6lunlE0. O�'A+ER OF UTnEH OMwf31J Niui�ERrv AxD OESCRIP1qM OF�11M�m Wt0 J(IYNlO'CAYEl10W TK.M116ER(5) nt�:........ . . .. � ACCTYP - .-•.. NPFRATIVE: � '+ O1 O 1 �y SUII WS � �•iR . -»:a Vehicle # 1 was heading E/6 0❑ University Ave. 03 � � I � towards Hamline Ave. Vehicle d 1 is a fully � '-OCAiM1 r �T��E � g" I b i I " marked squad car s had it's em.ergency li9hts O1 O1 ! � � acLivated but not it's siren. Vehicle # 2 was a� x� =:� heading S/B on Ham line A v e. app r o a c h i n g "'T"E� N ° _ _ _ _ :" University Ave. Vehicle # 2 had the qreen light ` 07 rneoFwz ' -��:. for North / South traffic on Haml�ne Ave. Vehicle � � �� - - � # 1� had it's opticom activated but *_he tcaffic . ` 03 � liqht was still red. Vehicle H 1 then entered the.: `cws��z - � �.; - intersection and stiuck Vehicle # 2 in the right ^�ATM�� f� r zear passenger area. - 02 �sEr�n - - �.•,: '_w6m�Fn: t , ROE5l3N - -. � � 11G11i 05 u�w«.a�. ��' A„s„� -- ' b �a - 04 ,a OS � I I I I � �°'� °,� i i i� - Y a..cww �'�"� �. 05 � O 1 :.�> _ _ __ _ _�___ A4ENGY W�liNLBTATIDN �ST.C!EV11iRDL IOLAI OFFIGER NW11C nNME MJD BMGE e - Sergeant Kent Cleveland 214 St Paul PD �]�F. ❑o,�R i EXHIBIT � � � http://www.dvslesupport.org/dvsinfo/accidentrecords_2008/Includes_LE/PrintReportIndiv_... 3/1/2012