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Vue . � S�� {tAT�lARri Providing lnsurance and Finar�cial Services � tMfYlANC� Nome Qffice,Bloomington,iilinois fi1710 R�.-„�-3�a�,� �:� 4. April 26, 2012 MAY �J � Z�12 C�T'� �L`F�K �ity of St Paul State Farm Claims Office of the City Clerk P.O, Box 2371 15 W Kellogg Blvd, 310 City Hall Bloomington IL 61702-2371 St Paul, MN 55102 , Certified Mail-Return Receipt Requested � RE: Claim Number: 23-05L2-090 Our Insured: Bee Vue Date of Loss: February 23, 2012 Your Insured: St Paul Police Your Insured Driver: Joshua Raichert Loss Location: Pennsylvania & Hwy 35, St. Paul, MN '� ; Sir or Madam � � Facts of Loss Insured was traveling behind police vehicle in the left lane. Insured merged into the right lane. Police car then merged into the right lane and struck the driver side of insured's vehicle. � It is our understanding that you are self insured. Our investigation indicates you are responsible for this claim. Therefore, we are seeking recovery from you. This letter is to notify you of our , subrogation claim and request your cooperation in settling this matter. To assist you in your review, here is a breakdown of the amounts State Farm paid by Cause of Loss: 041/045 - Uninsured Motorist BI $ 042 - Uninsured Motorist PD $ 300 series/400 - Comp/Collision $1,827.22 501 - Rental/Loss of Use $ 600-050 - Med Pay/PtP $ � Other $ Salvage Recovery $ ', Amount State Farm Paid $1,827.22 Insured Deductible $250.00 Total Claim Amount $2,077.22 Based on the assessment of liability between the parties, State Farm Mutual Automobile Insurance Company is seeking 100% of the Total Claim Amount listed above. The amount payable to State Farm Mutual Automobile Insurance Company for this loss is $2,077.22. . � 23-05L2-090 Page 2 "; April 26, 201� Please remit payment of this claim and include our claim number on the payment. If you have any questions or need additional information, please call me at the number listed below. If I am not available, any other member of my team may assist you. Thank you for your cooperation. In order to assist you in evaluating and processing the subrogation claim we are asserting, we may provide nonpublic personal information about our customer. We are sharing this information to effect, administer, or enforce a transaction authorized by the consumer. However, you are neither authorized nor permitted to: (1) use the customer information we provided for any purpose other than to evaluate and process the subrogation claim, or(2) disclose or share the customer information we provide for any purpose other than to evaluate and process the subrogation claim. Sincerely, a Ed comb Y J Claim Processor (877)457-8276 Ext. 52957 Fax: (866) 231-9276 State Farm Mutual Automobile Insurance Company Endosure i � ; � I i � � � **HEADER PAGE** Casey Scheuer 23-OSL2-090 Printed: 12:14:11 May/O1/2012 Product Line: Auto Claim Number: 23-OSL2-090 Insured Name: LEE, PAKOU Requestor Name: Casey Scheuer Alias: MBIU Printer: CPCL2580 Comments: � STATE FARM INSURANCE COMPANIES � 500 SOUTH 84TH STREET LINCOLN, NE 68510-2611 ' SUPPLEMENT FAX: (MN,WI) 800-230-1949 SUPPLEMENT FAX: (IA,NE,ND,SD) 800-455-9697 *** ESTIMATE *** 03/09/2012 02:52 PM Owner Owner: PAKOU LEE Address: 430 VAN BUREN AVE City State Zip: SAINT PAUL, MN 55103-1533 Home/Day: (651)276-2769 Work/Day: (651)216-4952 Control Information Claim # : 23-05L2-09001 Loss Date/Time: 02/23/2012 06:00 AM Loss Type: Collision Deductible: $250.00 Ins. Company: State Farm Insured: PAKOU LEE Work/Day: (651)216-4952 Home/Day: (651)276-2769 Claim Rep: TEAM R3 ACC CP Work/Day: (866)207-6046 Inspection � Inspection Date: 03/09/2012 02 :52 PM i Inspection Type: Drive In Primary Impact: Left Side Driveable: Yes Received Date/Time: 03/09/2012 03:01 PM Appointment Date/Time: 03/09/2012 03 :56 PM Appraiser Name: TOM JOHNSON Remarks FOR SUPPLEMENTS FAX #800-230-1949 OR LOCAL FAX #651-365-9370 INSPECTION LOCATION MAPLEWOOD DRIVE IN Vehicle � 2002 Toyota Camry LE 4 DR Sedan � 4cyl Gasoline 2.4 4 Speed Automatic Lic.Plate: SCK705 Lic State: MN Lic Expire: 02/2013 VIN: 4T1BE32K72U511528 � Prod Date: 09/2001 Mileage: 146,913 i Veh Insp# : Mileage Type: Actual � Condition: Code: Y1743B Ext. Refinish: Two-Stage Ext. Color: LUNAR MIST SILVER PRL MET Ext. Paint Code: 1C8 Int. Refinish: Two-Stage Options Air Conditioning Bucket Seats Center Console Compact Disc W/Tape Cruise Control Dual Airbags 2002 Toyota Camry LE 4 DR Sedan 03/09/2012 03:03 PM Page 1 of 4 L131ID � : 6S-USLL-UyUUl US/Uy/LUlL Intermittent Wipers Lighted Entry System Overhead Console �ower Brakes Power poor Locks Power Mirrors t Power Steering Power Windows Rear Window Defroster Rem Trunk-L/Gate Release Split Folding Rear Seat Steel Wheels Tachometer Tilt Steering Wheel Tinted Glass Velour/Cloth Seats Damages Ln# Op GDE Description MFR.Part No. Price AJ% B% HRS R --- -- ---- -------------------- ---------------- -------- -------- ---- -- 1 I 209 Pn1,Front Door Ou LT Repair 4 .0* SM 2 L 209 Pn1,Front Door Ou LT Refinish 2 .6 RF 2.2 Surface 0.4 Two-stage 3 RI 258 M1dg,Front Door B LT R & I Assembly 0.3 SM 4 E 254 M1dg,Front Door S LT 75732AA070A0 62.23 0.4 SM MC O1 5 RI 229 Mirror,0uter R/C LT R & I Assembly 0.3 SM 6 I 227 Handle,Front Door LT Repair 0.3* SM 7 L 227 Handle,Front Door LT Refinish 0 .4 RF 0.3 Surface 0.1 Two-stage 8 RI 227 Handle,Front Door LT R & I Assembly 0.8 SM 9 I 289 Pn1,Rear poor Out LT Repair 4 .0* SM 10 L 289 Pnl,Rear poor Out LT Refinish 2.2 RF 1.8 Surface 0.4 Two-stage 11 RI 319 M1dg,Rear poor Be LT R & I Assembly 0.3 SM 12 E 323 M1dg,Rear poor Si LT 75742AA050A0 62.23 0.4 SM MC O1 13 RI 305 Handle,RR Door Ou LT R & I Assembly 1.0 SM 14 BR 43 Panel,Roof Side LT Blend Refinish 1.5 RF MC 13 0.6 Blend 0.6 Two-stage setup 0.3 Two-stage 15 RI 256 M1dg,Roof Drip LT R & I Assembly 0.3 SM 16 I 389 Panel,Quarter LT Repair 1.0* SM 17 L 389 Panel,Quarter LT Refinish 2 .8 RF 2 .3 Surface 0.5 Two-stage 18 BR 397 Door,Fuel Filler LT Blend Refinish 0.2 RF 0.1 Blend 0.1 Two-stage 19 RI 397 Door,Fuel Filler LT R & I Assembly 0.3 SM 20 E 185 Shield,Quarter Pa LT 58748AA010 12.21 SM � 21 RI 559 Lens,Taillamp LT R & I Assembly 0.3 SM ' 22 N 566 Rear Bumper Cover R& ADDITIONAL OPERA 1.2 SM � 23 I 566 Cover,Rear Bumper Repair 1.0* SM , 24 L 566 Cover,Rear Bumper Refinish 2.7* RF MC 10 2 .2 * Surface 0.5 Two-stage » TIME IS TO SPOT COLOR WITH FULL CLEAR 25 E M03 Flex Additive NEW PART 4.00* RF 26 L M14 Corrosion Protection Refinish 0.3* RF 27 E M17 Cover Car Exterior NEW PART 4 .00* RF 28 SB M60 Hazardous Waste Remo Sublet Repair 3 .00* SM 29 I ROPE GLASS MOULDINGS Repair 0.5* SM* 29 Items 2002 Toyota Camry LE 4 DR Sedan 03/09/2012 03:03 PM Page 2 of 4 Lldlm � : Lj-USLL-UyUU1 US/U7/6U1L MC Message � O1 CALL DEALER FOR EXACT PART # / PRICE 10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE Estimate Total & Entries Gross Parts $144 .67 Paint Materials $406.40 Parts & Material Total $551.07 Tax On Parts Only @ 6.875% $9.95 Labor Rate Replace Hrs Repair Hrs Total Hrs Sheet Metal (SM) $52.00 4.4 12.0 16.4 $852.80 Mech/Elec (ME) $75.00 Frame (FR) $75.00 Refinish (RF) $52.00 12.7 12.7 $660.40 Paint Materials $32.00 Labor Total 29.1 Hours $1, 513 .20 Sublet Repairs $3 .00 Gross Total $2, 077.22 Less: Deductible $250.00- Net Total $1, 827.22 Alternate Parts Y/00/00/00/00/00 CUM 00/00/00/00/00 Zip Code: 55120 METRO Recycled Parts NOT REQUESTED Audatex Estimating 6.0.726 ES 03/09/2012 03:03 PM REL 6.0.726 DT oa/oi/aoiz DB o3/os/aola Copyright (C) 2011 Audatex North America, Inc. 2 .9 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. ANY PERSON WHO SUBMITS AN APPLICATION OR FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS CONIMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. THIS IS AN ESTIMATE. REPAIR FACILITES MUST INSPECT THE VEHICLE TO DETERMINE IF ANY REPAIRS NOT LISTED ARE REQUIRED, AND TO CONTACT STATE FARM BEFORE MAKING SUCH REPAIRS. REPAIRER ALSO IS RESPONSIBLE FOR CONDUCTING ANY NECESSARY INSPECTION AND SAFETY CHECKS PRIOR TO AND AFTER COMPLETING REPAIRS. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ' WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE PARTS MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE. A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. Op Codes * = User-Entered Value E = NEW PART NG = Replace NAGS ' EC = ** NON-OEM PART ET = Partial Replace Labo EP = ** NON-OEM PART � EU = RECYCLED PART TE = Partial Replace Pric PM = REMAN/REBUILT PART UM = REMAN/REBUILT PART L = Refinish PC = RECOND PART UC = RECOND PART TT = Two-Tone SB = Sublet Repair N = ADDITIONAL OPERATION BR = Blend Refinish I = Repair IT = Partial Repair CG = Chipguard RI = R & I Assembly P = Check RP = RP-RELATED PRIOR This report contains proprietary information of Audatex and may not be disclosed to any third party (other than the insured, 2002 Toyota Camry LE 4 DR Sedan 03/09/2012 03:03 PM Page 3 of 4 Lld1m # : GS-U7LL-UyUUl US/Uy/LUlL claimant and others on a need to know basis in order to �ffectuate the claims process) without Audatex' s prior written ' consent. Copyright (C) 2011 Audatex North America, Inc. i � 2002 Toyota Camry LE 4 DR Sedan 03/09/2012 03:03 PM Page 4 of 4 , �zn- �= ;. � �� }�� ,�. � ° � � . i 3a��X ,. 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"+c�� .,� _ uEa�N •�"3i:.;'" �� z'�.. � � ��.�� i z� � � � � r � ..�-�s '�'�,,� �.' - � :< s-�` ��,. �� `� �. �� 4 ��: �� . �} � -z �� n<�� `'� a� �` ;,� P`� �,�,�s'=�,� ' _�� _ �? �>: _ r� � � � � �� I I i I I i 1 1 , 386480711 For Customer Support refer to the L�� appropriate platform below: OrderPoint 800-934-9698 Orderpoint support@lexisnexis com Accurint for Insurance 866-277-8407 Accunnt support@lexisnexis com Lexis.com REPORT ATTACHED Law Firm accounts 800-543-6862 PAGE COUNT: 16 CLIENT : SF5215 DIVISION : 10605993657 ADNSTER : BCLEVOl CLAIM : 23-OSL2-090 TRANSACTION# : 386480711 DATE : 04/Ol/2012 DATE DF L�SS : 02/23/2012 TIME OF LDSS : 04:00 PM STREET : PENNSYLVANIA AND HWY 35 CITY: ST. PAUI, COUNTY : RAMSEY STATE: MN INVESTIGATING AGENCY : ST.PAUL PD REPORT NUMBER : 12042456 REPORT TYPE : Auto Accident PARTY 1 : BEE VI_TE PARTY 2 : RAICHERT PARTY 3 : CAR : MAKE : YEAR : TAG : DRIVER LICENSE : ADDITIDNAL INFO : POLICY#: ' POLICY STATE: �' L�SS KIND: NOTE : THANK YOU FOR YOUR ORDERi 10Ch1209200079 1 1 . 3864$07,11 Accident Report � ' xcw.w_ Y� �2aaz4s6 ' � -�n..00�w ,• owo .w.a.. .uc ..+v ,.r � o.a °yI'hu nv�ua N •N d2 b0 �0 l� 2 23 O12 1613 �k, �..,.�w �,�,..�„�� .o,o.`�. ��.6 A _ _B, 8: B:a� _ �, 10 Phalen Blvd a ` .n.,ar a.w.w.rn �anesx �ww�.anr-cca.�..�_a.in*M[ 62� �.. 3425 ♦_• DI 35 E . �� uro��axn�uurs.�.sm� .an u.r �.n.im rarm. e�rtw�cnmxuo�� mr. vw ar�.�tv �.*�r� Ol G7870690982Z2 I+A1 D O1 5249185372715 [+�I D Ol �A a w�arrne�un aenr. owr.i�vnroei,�.u�i u�elwn u�na�i � BEE V[IE O1 20 87 JOSHUA EARL RAICHERT 11 25 75 � RiACI �OOtb PN4+ 08 430 VAN BUREN AVE N; O1 367 Grove St. N•, O1 1a ry�*y .R/lAR3 -.J�� iR(WLY� �02 ST anuL 55103 ssi-:�e-oiav St. Paul 55337 651-791-1111 Ol �ra.c ra � �r .,ww .m v. �oe� �a� g.v�� ...rmv� ,.s�. cc� w� .on.o Ol `�"•` M 4 "`04 06 OS N • M �4 °`04 06 OS �1J O1 �� c *.c +a.:v iawawr .rK�aaarr.-c ..w.a m . wr...r� r+as,�w,�.o.i w+.�..owa ►ru..e�. 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' . � .,,... . . ... .,._.. ...,,.,. ., - .. . fM1f'P"t �. .. � . .. . . .. . � JRS1111JI�CIiIRAWS�.�• �OfIS� �'A0.R��'O� Ql�CS�IP111❑IOIYI sgt_ Paul Rhodes 153 St Paul PD p„w. ❑o,�.� http://www.dvslesapport.org/dvsinfo/accidentrecords 2008/Includes LE/PrintReportIndiv.., 2/24/2012 �or.n+�na�onoss i i . 386480?,11 Saint Paul Police Department Qa9e ' °fZ ORIGINAL OFFENSE / INCIDENT REPORT Complamf Number Reference CN Date and Time o!Report 12042456 02/23/2012 17:51:00 Pnmary offense: TRAFFIC ACCIDENT-SQUAD CAR PnmaryReportingO�cer. Rhodes, �aul D Nameoflocat;on/business: Pnmarysquad 67a c.ocationofincident:�35E FW N & PENNSYLVANIA Secondary reporting oN�cer: M N �5101 Approver. RhOdes, Paul D,sr��t: Eastern Date 8 time of occurrence. 02/23/2012 16:13:00 to S�te: 02/23/2012 17:51:0 Q Arrest made� Secondary oHense: Police O�cerAssaulied orinjured: Police O�cerAssrsted Suicide Crime 5cene Processed: I OFFENSE DETAILS ; TRAFFIC ACCiDENT-SQUAD CAR ! Attempt Only: Appears fo tre Gang Related: NAMES Suspect UNKNOWN IYicknames or Aliases Nick Name: Alias: AKA First Name: AKA Last Name: Detaffs Sex: Race: DOB: Resident Status: Hrspanic: Age� from to � Phones Nome: Ce!!: Contact: Work: Fax Pager. Employment Occupaflon: Employer. SP301568F76460F 10ch1209200084 1 1 . 386480711 I �, 1 1 � 386480711 Saint Paul Police Department Pa98 z ofz ORIGINAL OFFENSE / INCIDENT REPORT Complainf Number Relerence CN Date and T,me olReporf 12042456 02/23/2012 17:51:00 Primary offense: • TRAFFIC ACCIDENT-SC�UAD CAR ldenflRcallon SSN� Ucense or10#: License State. Physica!Description US: Metnc Herght to Sudd: Hair Length: Narr Color, Weight: !o Skm: Facia!Nair: N&i�Type: Teefh• Eye Color. 81ood Type: OlfenderinlormaGon Arresfed• Pursurt engaged� Violafed Restraining Order. DU! Resrstance encountered: CondRion: Taken to health care facility: Medical�e/ease obtained. SOLVABILITY FACTORS Saspecf can be ldentifred: 8y: Photos Taken: Stolen Pr�peRy Traceable: Evidence Tumed In; Property Tumed ln.• Related Incrdent. La6 8iological Anatysis: Fingerprints Taken: NarcoGc Anatysis: ltems Fmgerpnnted: Lab Comments• Participants: Person Type: Name: Address: Phone: Suspect NARRATIVE City veh, involved, property damage accident. photos taken by sqd 23Q. For further info see state accident report, and supp. report. PUBLIC NARRATIVE Traffic accident SP301568F76460F +ar.n��nA�onoRs 1 1 . 3864807.11 �ocn��nA�onoa� 1 1 . 386480711 Saint Paul Police Department Pa9e , °�z SUPPLEMENTAL OFFENSE / INCIDENT REPQRT Complaint Number Refe�nCe CN Date and Time o(Report 12�42456 02/23/2012 18:54:00 Pnmary offense: TRAFFIC ACC�DENT-SQUAD CAR Pnmary Reportfng Officer. �/all, Len M Name otlocatioNbusiness: Primerysquad: 230 Location ofincident:�35E FW N& PENNSYLVANIA Secondary reporting olicer. ST PAIJL, MN 55103 APp�Vef Simmons, Michael District Central �are 8 trme o�occu,rence. fl2/23/2012 16:13:04 ro sire, 02/23/2012 98:54:OQ Arrest made� Secondary offense. Police O�cerAssaulted or lnjwed Police O�cerAssisted 5uicide: Crime 5cene Processed: OFFENSE DETAILS TRAFFIC ACCIDENT-SQUAD CAR .4ttempt Only_ Appears to Ae Gang Related: SOLVABILITY FACTORS Suspect can be Identi6ed: gy. Photos Taken: Stolen Property Traceable• Evidence T�med In P�pperty Tumed!n: Related Incident. Lab 8iologica!Artalysis: Fingerprints Taken: Narcotic Analysis: ltems Fingerprinted: Lab Comments Participants: Person Type: Name: Address: Phone: NARRATIVE 4n 02-23-12 at about 1630 hours, Squad#23Q (Wall)was dispatched #o Olive/Phalen Parkway to take photos of an ACCIDENT. List of Photos for CN 12042456: SP30'1568F76460F +n�ti��no�nnnus i i , 386480711 Saint Paul Police Department Pa9e 2 °'2 SUPPLEMENTAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and Time of Report 12042456 02/23/20�2 18:54:00 Pnmary offense TRAFFIC ACCIDENT-SQUAD CAR 1. 1204245fi-02232012_163506-ACClDENT-1.jpg - REAR OF V#1 2. 12042456-02232012_163512-ACCIDENT-2.jpg - REAR LlCENSE PLATE OF V#1 3. 12042456-02232012 163518-ACCIDENT-3.jpg - L�FT SIDE OF V#1 4. 12042456-02232012_163524-ACCIDENT-4.jpg - DAMAGE TO DRIVER'S DOOR V#1 5. 12042456-02232012 163527-ACCIDENT-5.jpg - DAMAGE TO DRIVER'S DO�R V#1 6. 12042456-Q2232012�163538-ACCIDENT-6.jpg - DAMAGE TO DRIVER'S DOOR V#1 7. 12Q42456-02232012_163543-ACCIDENT-7.jpg - DAMAGE TO ORIVER'S DOOR V#1 8. 12042456-02232012 163551-ACCIDENT-8.jpg - LEFT 51DE OF V#1 45 D�GREES 9. 92Q42456-02232012_163557-ACCIDENT-9.jpg - FRONT OF V#1 10. 12042456-02232012 163559-ACCIDENT-10.jpg - FRONT OF V#1 11. 12042456-02232012_16360fi-ACCIDENT-'f'l.jpg - REAR OF V#2 12. 12042456-02232012_163621-ACCIDENT-12.jpg - RIGHT SIDE OF V#1 13. 12042456-02232012 163fi32-ACCIDENT-13.jpg - RIGHT SIDE OF V#2 14. 12042456-02232012 163639-ACCIDENT-14.jpg - RIGHT SIDE OF V#2 15. 12042456-02232012 163645-ACCIDENT-15.jpg - FRONT RIGHT CORNER DAMAGE TO V#2 16. 12042456-02232012_163650-ACCIDENT-16.jpg - FRONT RIGHT CORNER DAMAGE TO V#2 17. 12042456-02232012_163653-ACCIDENT-17.jpg - FRONT RIGHT CORNER DAMAGE TO V#2 18. '12042456-02232012 163700-ACCIDENT-18.jpg - FRONT RIGHT CORNER DAMAGE TO V#2 19. 12042456-02232012 1fi3707-ACCIDENT-19.jpg - FR�NT RIGMT CORNFR DAMAGE TO V#2 2fl. 12042456-02232012_163714-ACCIDENT-20.jpg - FRONT LiCENSE PLATE V#2 The labeled photos were TRANSFERRED to the Media Vault. PUBLIC NARRATIVE PHOTOS. � i i i SP301568F76460F tOch1209200089 i i . 386480711 Saint Paul F�olice Department Pa9e ' of2 SUPPLEMENTAL OFFENSE 1 INClDENT REP4RT Complaint Number Reference CN Oate and Time of Repat 12042456 02�24�20�� oo,�s:oo Pnmary oNense: TRAFFlC ACCIDENT-SQUAD CAR Primary RepoRing O�cer. Rhodes, Paul D IVame of location/business. Primarysquad� 670 Locationofrncident: 135E FW N $ PENfVSYLVANIA Secondaryreportirtgo�cer MN 551d1 ,4pprover. RhOd�s, Paul Disfrrcf:Centrai Date&time o�occurrence: p2/23/2012 16:13:00 to s��: avza�2o�z is:oa:oo Anest made; 5econdary oftense: Police O(ficer Assaulted or lnjured: Police O�cerAssisfed Surcide: Crime Scene Processed: OFFENSE DETAILS TRAFFIC ACCIDENT-SQUAD CAR Attempt dnly: Appears to be Gang Related: SOLVABILITY FACTORS Suspecf can be ldentified: gy: Phofos Taken: Siolen Pmperly Traceable. Evidence Tumed!n• Properfy Tumed In• Related lrtcidenf. Lab Biologicai Anatysis: Fingerprints Taken. ' Nar�otic Analysis: Items Fingerpnnted' Lab Comments. Participants: Person Type: Name: Address: Phone: NARRATIVE � MYSELF, OFFICERS, BILEK, ODONNELL, AND RAICHERT WERE RIDING IN UNMARKED VEH. UC# � PRJ649. RAICHERT WAS DRIVING WI7H BILEK IN THE FRONT SEAT AND MYSELF REAR SEAT, DRIVERS SIDE ANQ ODONNELL WAS REAR SEAT, PASSENGER SIDE. WE WERE EAST BOUND ON PHALEN BLVD. STOPPED IN TRAFFIC ON THE INSIDE LANE, WAITING SP301568F7646UF 10ch1209200080 1 1 . 386480711 Saint Paul Police Department Pa9e z °'Z SUPPLEMENTAL OFFENSE 1 INCIDENT REPORT Complaint Number Reference CN Date and Trme o/Repo�t 'I2042456 02/24/2Q12 00:16:00 Primary offense: TRAFFIC ACCIDENT-SQUAD CAR FOR TNE RED LIGHT. ONCE IT TURNED GREEN WE REMAINED STOPPED BECAUSE THERE WAS A MTC BUS STOPPED, ATTEMP7ING TO TURN NORTH ON MISSISSiPPI BLVD. ONCE TRAFFIC HAD CLEARED ON THE OUTSIDE LANE RAICHERT STARTED TO MOVE OVER. AS HE WAS ENTERING THE LANE I WAS TURNED AND SAW THE S7RIKING VEH COME UP FROM THE SIDE, THIS VEH. APPEARED BE MOVING RATHER FAST FOR THE AMOUNT OF TRAFFIC AROUND. THIS VEH. KEPT DRIVING PAST US STRIKING/SCRAPING THE FRONT RIGHT BUMPER OF OUR CAR. CAUSING DAMAGE TO OUR RIGHT FRONT BUMPER AND LIGHT. THE OTHER VEH SUSTAINED DAMGE TO ITS DRIVERS SIDE DOOR AND PASSENGER DOOR. PHOTOS WERE TAK�N OF DAMAGE BY SQD 230. WE HAD VEH Pl}LL OVER NEAR OLIVE AND PHALEN BLVD. I WENT TO SPEAK THE THE DRIVER, BEE VUE, 1-20-87, HE WAS UNABLE TO SPEAK ENGLISH SO I HAD THE PASSENGER, PA KOU LEE, 8-15-89, TRANSLATE FOR ME. 1 ASKED WERE THEY HAD BEEN PRIOR TO ACCIDENT. LEE TOLD ME THEY HAD BEEN STOPPED IN TRA�FIC A NUMBER OF CARS BACK FROM US IN THE SAME LANE AS US. WHEN THEY SAW THE BUS HAD EVERYTHING S70PPED THEY ALSO CHANGED LANES AND WEADED �AST. THAT IS WHEN THEY SIDE SWIPED OUR VEH. I AKSED LEE TO ASK SEE HOW FAST HE WAS TRAVILING PRIQR TO THE ACCID�NT? LEE TOLD ME BEE SAID HE WAS GOING 25 TO 30 MPH. WE THEN LEFT TH�M WITH THE CASE NUMBER AND HEADED BACK TO EAST DISTRICT. IT SHOULD BE NQTED THAT NO ONE IN EITHER VEH WAS INJURED_ PUBLIC NARRATIVE City veh. property damage accident � � SP301568F76460F �a:n��n9�000�� 1 1 . 386480711 Saint Paul Police Department Page ' °f2 SUPPLEMENTAL OFFENSE 1 INC�DENT REP�RT Complaint Number Reference CN Date and Time of Repai 12042456 02/24/2012 0�:35:00 Primary offense. TRAFFIC ACCIDENT-SQUAD CAR Pnmary Reporting a�cer: RaICh2ft, JOShUB IVame of locatian/business. Pnmarysquad 673 Locationofincident. 135E FW N&PENNSYLVAN�A Secondary reporting o�cer. M N 55106 pAP�Ve�' Rhodes, Paul fl;stn'ct: Eastern Date&time of occurrence: p2/2312012 16:13:00 to site. 02/23/2012 16.13:00 Arcest made: Secondary offense Police OffrcerAssaulted or In�ured Police O�cerAssisted Suicide: Crime Scene Processed. OFFENSE DETAILS TRAFFIC ACCIpENT�QUAD CAR Attempt Onty: Appears to be Gang Relaled: SOLVA6ILITY FACTORS Suspect can be Iden�ed� gy. Photos 1"aken 5to/en Property Traceable• Evidencs Tumed Jn, Property Tumed In: Related lncrdent: Lab 8iologica!Anafysis- Frngerprints taken: Narcotic Analysis: Items F�nge�printed: Lab Comments. I � Participants: Person Type: Name: Address: Phone: NARRATIVE On 02/23/12 at appraximately 1600 hours I, I squad 673 {RAICHERT)was driving MN PRJ649. I was in the number one lane, stopped in traf#ic, facing eastbound Phalen Blvd under 35E. Several cars ahead of ine, in the same lane, a MTC bus was attempting fo make a left turn onto Mississippi ' Blvd. I used my rearview, side view, and looked over my shoulder to ensure the number two lane was clear SP301568F7648Uf 10CM20920D092 1 1 . 386480711 Saint Paul�Police Department Pag� z °'2 SUPPLEMENTAL OFFENSE / INCIDENT REPORT Complaint Number Reference CN Date and�me of Report 12042456 02/24/2012 00:35:00 Primary offense� TRAFFIC ACCIDENT-SQUAD CAR before entering. I noticed two vehicles approaching so I initiated my right turn signa! and waited for them to pass. Once the vehicies passed I again checked all mirrors and looked over my shoulder and found the lane to be clear of vehicles. I slowly began to turn into the lane from a completes stop. Once I had moved approximately two feet into the number to lane I noticed a vehicle approaching rapidly in the number two lane. I applied my brake to stop and the vehicle continued speeding up. As I came to a stop the vehicle in the number two�ane continued taward me without sfowing or diverting iYs direction at all as if the driver didn't see me at all. Ti�e vehicle in the number two lane struck my vehicie making contact with my front passenger side light of the vehicle and continued driving, without slowing causing damage to the driver's side door and driver's side passenger doo�. The vehicle, MN SCK705 didn't attempt to slow or stop until it had completely passed my vehicle. Once stopped I directed the driver, BEE VUE, 01/20187, 430 Van Buren Ave, to pull ahead out of traffic. Front seat passenger, was identified as PA KOU LEE, 08115189. VUE didn't speak english so Lee translated for him. I asked where they came from and Lee said that ti�ey came from the number one lane because they were stuck in traffic. I asked how many cars behind me they were prior to moving into the number two lane and they tt�ought about three cars. I asked if they saw me in the lane and tF�ey said "No." I asked if they were accelerating rapidly and they didn't answer. I asked how fast they were going and they thought"30 mph." Squad 230 arrived for photos. See Sgt Rhodes Report for further. PUBLIC NARRATIVE Supplemental report. SP3D1568F76460F +nrr,��no�nnnpz i i . 386480711 � � I �n�n��no�nnnod � � ��_::.: �:, �; �x.� _ �. � ��r � a s , .�"* �= �;: �,= �� .. �� ,..�. � � ., �x,. � c � -- � � � � \ � r�� ,� � � � . ..... , � '" e.�::.. �A. � � ..}� � ��-, , --�a�-�",�.vy . �, _ � � ,.. I ; �, ��,. �.3—o5La—aq,e� ' � NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota Minnesota S"ate Stan?e 466.05 states thar "..,every person...who claims damages from any mticnicipaliry...shall caa�se to be presented to the governing body of the municipaliry within I80 days after the alleged loss or inja�ry 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 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 Middle Initial Last Name Company or Business Name S'�Q.�e- �Q f rrl �ns�,ram.e P GL� S�rpqe,� D'� �U1,�e Are You an Insurance Company? Yes No If Yes, Claim Number? oZ 3' �5 �o�� U� Street Address 1- � Ic�6�L (d�•3`� � City �K> �6b11'1 �� State � � Zip Code �7 d a-3 `7 ( x 6 957 Daytime Phone(�)��Cell Phone( ) - Evening Telephone(_) - Date of Accidend Injury or Date Discovered o��a-3--�or1-- Time i �� am pm Please state, 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 respons' le for your damages. s rawe.l; b� ' S l�c ea ns rne rd ` � e �- `�' s'E- `� 'rc �°- vQ e '1-L �-c .� 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 ❑ 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 you need to include conies 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 li 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. 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 claim 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�nlease complete this secNon Were there witnesses to the incident? Yes �N Unknown (circle) Provide their names, addresses and telephone numbers: Were the police or law enforcement called? Yes No Unknown (circle) If yes, what department or agency? Case#or report# I a o y a ys 4 Where did the accident or injury take place? Provide street address, cross street, intersection, name of park or facility, closest land rk, etc. Please be as detailed as possible. If necessary, attach a diagram. PhGi I��A�� 3 S�� S+ �o�,�. 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. �a�C�'7 7, et� Vehicle Claims— lease com lete this section ❑ check box if this section does not a 1 Your Vehicle: Year�.DO� Make To�l o�A Model r License Plate Number SC 1� State v1 Color L.cc.�u,r tY)�s�' Registered Owner � 1/tti Driver of Vehicle t,� Area Damaged P�r�;�i re e.�-4 S i ol�. City Vehicle: Year�r,oS Make Ford Model �Pi� License Plate Number_�'R� �i'�9 State Color IQ,¢k Driver of Vehicle(City Employee's Name) JdS �6 .� , G1 ich.�r� Area Damaged h:Q.�-s �d.e_ _Injurv Claims—please complete this section �check box if this section does not applv 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 Did you miss work as a result of your injury? Yes No When did you miss work? (provide date(s)) Name of your Employer: Address Telephone ❑ Check here if you are attaching more pages to this claim form. Number of additional pages � By signirtg this form,you are stating that all information you have provided is true and correct to the best j of your knowledge. Unsigned forms will not be processed. ' Submitting a false claim can result in prosecution. Date form was completed ��_Q_a�o.a-O I� Print the Name of the Person who Completed this Form: ��on�b Signature of Person Making the Claim: � �U Revised February 2011 RBZ0006Z STATE FARM State Farm Mutual Automobile Insurance Company Auto Payments by COL �NSU��NCe Route To: Casey Scheuer BASIC CLAIM INFORMATION Claim Number: 23-05L2-090 Date of Loss: 02-23-2012 Policy Number: 1360-507-236 Named Insured: LEE, PAKOU 400 -COLL C denotes consolidated payment E denotes EFT payment P previously converted payment from CAT/CMR Payment Payable Pay Rsn Number Issued Date Participant COL Cd Status Amount Auth ID Cd 105089650J 03-09-2012 Named Insured(s) 400 1 Paid $1,827.22 GDFX Total: $1,827.22 Date: 05-01-2012 Page 1 This report includes only ECS Claims. FOR INTERNAL STATE FARM USE ONLY Contains CONFIDENTIAL information which may not be disclosed without express written authorization.