Reeg . NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota
Minrsesota State Statute 466.05 states that"__.every person...who claims damages from any municipality__.shall cause t�¢���Jeiedab the
' governing body of the municipality within 180 days after the alleged loss or injury is discovered a notice stating the'tifme, la,r�e,ancl
' circumstances thereof,and the amount of compensation or other relief demanded" �t�� �J :� 2��2
Please complete this form in its entirety by clearly typing or printing your answer to each question rR�s���
needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify e ,s�'�f as
�eh information as necessary to eacplain your ctaim,anc�the amount of compensation being requested. You will receive a
written acl�owledgement 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 some°ng 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
F'ust Name �AcV� � Middle Initial J Last Name 1�'�-E E�
Company or Business Name i�►l�
Are You an Insurance Company? Yes No If Yes,Claim Numbec?
Street Address �2� �u�v �v�u-�
City S/�rl�'� P��l-- _ State �� Zip Code ����
Daytime Phone((g�.)��!b- �Z`�2 Cell Phone((051 )2�- 3 Z�z Evening Telephone(�x�-� �ob
Date of Accidend Injury or Date Discovered t-�O�C1� �� ?i0 l Z. Time am/pm
PIease state,in detail,what occurred(happened),and why you aze 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 damages. N1 -�
s-1 r � w as c...�� �a,,,� r-c�_ o., S `,c.�C �,�e. u�. -k r-t a�r-I�.o,-�se
'-E ^�n : � b`�' �n1` O� ,�... O '�"
t �4; ,,a c c,�rz�, .1 �. ,.,-�.�`t- �
-►-o-�1�e.- �r►�-e-^`cz��1.��.��-� -
P�ease cTieck the box(es)that most closely represent the reason for completing this form:
0 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 O My vehicle was damaged by a plow
❑My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property r ,�,,
'�L(,Other type of property damage—please specify V����.1 S��i�� �1�..�,�� Crm-c1,c�.� � `��.� bu�t�-�►3�h�e,
❑ Other type of injury—please specify
In order to process your claim vou nced to include couies of all apulicable 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 aze 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 velucle 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
• 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-please complete this section
Were there witnesses to the incident? Yes � Unknown (circle)
� Provide their names, addresses and telephon umbers: � � �S —�.J;`��2sS
r a n�., S� -I- l - Z.—Z
Were the police or law enforcement cailed? Yes � Unknown (circle)
I€yes,what department or agency? Case#or report# ___
Where did the accident or injury take place? Provide street address,cross street,intersection,name of pazk or faciiity,
closest landmark,etc. Please be as detailed as possible. (If necess/ary,attachpa dia am.
�li�v ��t 1� N\�11J�-, [-.� ����1(/l.� I�� �""YC� TL�C.�hC `��/1�C�L?-'�l_ �tp.�11 t-P�.
Please indicate the amount you aze seeking in compensation or what you would like the City to do to resolve this claim
to your satisfaction. � wov�� �w� `ce. i�� �1�.� C� �,.i l�e, �c.a:�5�e,
!7'7 M� ll,I � Ih "� '37���'�C-. f- - � ' � � `+ ' � ° �
Velucl�e Clauns-please complete this section �heck box if this section does not applv
Your Vehicle: Yeaz Make Mad�l
License Plate Number State Color
Registered Owner
Driver of Vehicle
Area Damaged
City Vehicle: Yeaz Make Model
License Plate Number State �olc�
Driver of Vehicle(City Employee's Name)
Area Damaged
Iniury 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 medicai treatment? Yes No Planning to Seek Treatment(circle)
�Vhen did you receive treatment? (provide date(s))
Name of Medical Provider(s):
Address Tetephone I�,
Did you miss work as a result of your injury? Yes Na
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 signing this form,you are stating that all information you have provirled 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 �` � � �t71 Z--
Print the Name of the Person who Complet this Form:�av�� � IC�
Signature of Person Making the Claim:
Revised February 20ll
. ���,rid F�e�g
1280 JUNO AVENUE SAINT PAUL, MN 55116 =,
TEL 651-699-1960
Property Damage Claim Estimates
After the tree-felling accident which damaged our siding on the east side of our house, we got
estimates from several siding companies. We were concerned that the existing 15-year-old sid-
ing was too old and too faded to match with new siding, so we decided to get estimates for both
one side and for the whole house. The following table shows the range of bids we received:
B11N11�L.E D.S.BJ1HFt 11MD1NEST
E71TEi�ORS COt�IS7'RUCTWN E)C7'ERIORS
PI.tJS I
Replace siding and damaged window wrap $1,340.00 $3,125.00 $2,630.00
on east side
Reside whole house with 0.046 siding and $8,460.00 $7,948.00 $8,604.02 ,
foam insulation
After much consideration we chose to have Bainvilie Exteriors reside our whole house. We also
chose to use 0.044 siding (same as existing siding) and reuse the existing insulation to save
money. The final cost for residing the whole house was$5,330.00.
Compensation Request
I do not believe that residing only one side of the house would have been a satisfactory solution.
We selected the siding color closest to our existing siding from the catalog which Bainville pro-
vided, but the enclosed side-by-side comparison of siding fragments shows that they still have
observably different colors and textures.
It would certainly be nice if the city covered the cost of residing the whole house. At minimum,
I am requesting for the city to pay for half of the cost of residing our house as damage compen-
sation, which is$2,665.00.
Enclosures
1. Neighborhood image highlighting our house and showing the trees along Syndicate which
were felled by the city(picture provided by Greg Reese at Division of Parks&Recreation).
2. Photos of our house a couple of days after the incident occured, with a coupte of damage
closeup shots (pictures provided by Greg Reese at Division of Parks&Recreation}.
3. More closeup shots I took of the siding damage showing chips, cracks, and scratches to the
siding caused by the tree felling.
4. Bainville Exteriors estimates for residing both east side and whole house.
5. D.S. Bahr Construction estimate for residing east side of house.
6. D.S. Bahr Construction estimate for residing whole house.
7. Midwest Exteriors Plus estimate for residing east side of house.
8. Midwest Exteriors Plus estimate for residing whole house.
9. Bainville Exteriors contract for residing whole house. ,
10. Bainville Exteriors final invoice for residing whole house after work was completed (includes �'
additional window wrap requested after original contract was signed). ,
11. Samples of old siding and new siding for comparison. ,
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2434 Hillview Rd.
Moundsview, MN 55512
763-783-3994 Cel1:612-616-4399 Fax:763-7859589
MN LIC #20204603
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T'his agreement is entered between hereinafter referred to as the OW�TER, and �
BAINVTLLE EXT'ERIORS,INC.hereinafter referred to as the CONTRACTOR,
For a consideration hereafter stated to be paid by the OWNER, the CONTRACTOR hereby covenants and agrees
with the OWNER to the conditions stated above upon the real property of the OWNER in accordance with the
following terms and conditions:
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D.S. Bahr Construction,Inc. e
• � 9771 312th street way " °�
�,,.,m e, Cannon Falls,MN 55009 �
-��tiLic. #BC20734I
_ �, Twin Cities: (612) 722-1448
Mobile: (612) 221-1008
PRO L SUB D TO: HOME PHONE DATE
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We hereby submit speci�ications and estimates for. �
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1�£�KOP05�herby to furnish materials and labor-complete in accordance with the above speci�cations for the sum of:
Check payable Eo D.S.Bahr Construction,Inc.
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AII Materiel is gnarantced to be as speci6ed.All work to be completed in a workmanlike mattn
eccording to standard practices.Any alterations or deviations from thc above speeifica6ions Aut�'to � �
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imvt�it�g eura costs will be eicecut�l only upon written orders,and will become an exta�a over and SigYlB.tliY'C r��'�"��
This estimate.Alt�greements contingent upon strikes,accidmfs or cZedays beyond our control.
Pmperly Owner to carry fire,wind,theft,and other necessary insurance. Proposal may be withdrawn within days.
14CC£fT1�4NC$OF f'gOI'OS14L-'I'he above prices,specifications,
and conditions are satisfactory and are hereby accepted.You Are Signaiure
Authori7.ed to do work as specified.Payment will be made as outlined
Above. Date of acceptance
� ��o�as�L C�
� D.S. Bahr Construction, Inc. �,
• 9771 312th street way " �
� Cannon Falls,MN 55009 �
Lic. #BC207341
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Mobile: (612) 221-1008
AR SAL SUB 17TED T HOME PHONE DATE
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ST� I/''�a CELL PHONE
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CPI'Y, ,ZIP r,�J1 ,j�/)� E-MAIL
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We he��eby submit specifica ' and estimates for:
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�OP05�herby to furnish mate s and labor-complete in accordance with the above specifications for the sum of:
Check payable fo D.S.Bahr Construatioa,Inc.
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AII Materia[is guaranteed to be as specified.All work to be completed in a wor � ' ' er � r�
according to standard practices.Any aIterations or deviations from the above specifications Aut�'tOT'iZed ���`��� ���
im olving e.atra cosls will be executed only upon written orders,and wilI become an extra over end SI.griBt[ire
This cstimate.AII a,gr�ments conrix�gent upon strikes,accidarts or delays beyond our control.
Property Owner to cany fire,wind,theft,and oEher neccssary insurancc. Proposal may be withdrawn within�days.
�CC�'I'1�N�$OF f'�{OPOS1akI.- The above prices,specificalions,
and conditions are satisfactory and are hereby accepted.You Are Signature
Authorized to do work as speci�ied.Payment will be made as outlined
Above. Date of acceptance
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��DM��'`�Yt��� �`� � � z� Midwest Exteriors Plus
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��4 64515ycamoreCt. (��
Mapie Grove,MN 55369 $$B
• EXTER��RS �. ��: iNC (763}427-9696 �
��������'�_��'�`�- � � www.midwestpius.com �EMBER
SIDING PROPOSAL AND CONTRACT licensed#20010277 � Bonded � Insured
C tomer�la Phone Z Pr osal Mad ��
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Street Address Cell Phone Phone
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City Stat Zip �.,, / Email Da
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1. SPEC{FICATIONS:
Midwest Exteriors Plus inc. ("Contractor') hereby proposes to furnish the materials and perform the labor necessary for the
completion of the siding job in accordance with the specifications ("Specifications") stated below. If you as the customer
("Customer")agree to this proposal,Contractor agrees to perform the work("Work")according to the Specifications.
2. COST OF JOB:
Your total cost for the job will be: $ d•� ("1ob CosY'). All discounts included.
Payment to be made as foilows: $ down, balance upon completion of work.
3. WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
se ❑ Garage ❑ Other
tect siding,gutters,plants,bushes and yard as much as possible.
lace any rotten/damaged wood or additional carpentry work at$65 per man hour plus materiais over original job cost.
In premium house wrap and tape all seams per code.
nstall premium foam insulation,to all walis on: ❑ House ❑ Garage ❑Other
❑ 1/4inch ❑3/8inch ❑ Other
Reside wLi-th pr mium quality: Lap ❑ Vinyl ❑ Steel ❑ Other
BrandTb �G. ��P�'Yv�+'wL� Style%�O (�, �w+iht6� Color�G�
❑ Cover all windows and door casings with aluminum on: ❑ House ❑ Garage ❑ Other
Brand Style Color
❑ Cover all fascias with ❑ House ❑ Garage ❑ Other ,
Brand Style Color
❑ Caver all soffit with aluminum on: Color ❑ House ❑ Garage ❑ Other
❑ Install new 5"aluminum seamless gutters(0.32)and gutter apron: Feet Color
Install to: ❑ House ❑ Garage ❑ Other �
❑ Install new aluminum downspouts. ❑ 2 x 3 ❑ 3 x 4 QTY Color '
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OTHER WORK TO BE DONE: �
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WARRANTY: Contractor warrants that the Work will be free from defects caused by faulty workmanship according to standard
practices for a period of 10 years. Upon reasonable notice,Contractor will repair faulty work.
SEE REVERSE SIDE FOR IMPORTANT NOTICE
The Specifications,Job Cost,Payment Terms,Warranty and Other Terms and Conditions of this Proposal and Contract are
satisfactory and are hereby accepted by Customer. Contractor is authorized to do the work as s cified. Payments will be made as
outlined above.
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Homeowner Date Contractor ate
$4„ .��'� !��'S,f '��� �° 5
� D Midwest Exteriors Plus , �
��D���� 6451 Sycamore Ct. ��l
�
Maple Grove, MN 55369 B�
- EXTERIORS 3� �N� (763)427-9696
- �'�=`4��='�" " www.midwestplus.com �EMBER
SIDING PROPOSAL AND CONTRACT Licensed#20010277 � Bonded � insured
Customer Name Phone Pr osal M e By:
Vr� —�Z�z A� A'N'��
Street Address Cell Phone Phone
Z u�o Zo. 8'b• 4t
City,St e,Zip Email Dat
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1. SPECIFICATIONS:
Midwest Exteriors Pius Inc. ("Contractor")hereby proposes to furnish the materials and perform the labor necessary for the
completion of the siding job in accordance with the specifications {"Specifications") stated below. If you as the customer
("Customer")agree to this proposal,Contractor agrees to perform the work("Work")according to the Specifications. �
2. COST OF 106: x�Q�jS�TG a�fSG�u�,l �w t O�
Your total cost for the job will be: $ �
' ` � ("Job Cost"). All discounts included��� �Z
�ayment to be made as foilows: $_ down, balance upon completion of work. j
3. WE HEREBY SUBMiT SPECIFICATIONS AND ESTIMATES FOR:
(�use ❑ Garage ❑ Other� 5���,Sb7 y10�. wes�,��? �Gf�f
Pr tect siding,gutters,piants,bushes and yard as much as possible.
R lace any rotten/damaged wood or additional carpentry work at$65 per man hour plus materials over originai job cost.
Install premium house wrap and tape ali seams per code.
❑ Install premium foam insulation,to all walis on: ❑ House ❑ Garage ❑Other
❑ 1/4 inch ❑3/8 inch ❑ Other
Reside with remium qua�lity/• lap Vinyl ❑ Steel ❑ Other
Brand�� ���y�+.1H�4 Style 0.r., a Color
❑ Cover all windows and door casings with aluminum on: ❑ House ❑ Garage ❑ Other
Brand Style Color
❑ Cover all fascias with ❑ House ❑ Garage ❑ Other
Brand Style Color
❑ Cover all soffit with aluminum on: Color ❑ House ❑ Garage ❑ Other I
❑ Install new 5"aluminum seamless gutters(0.32)and gutter apron: Feet Color
Install to: ❑ House ❑ Garage ❑ Other
❑ Vnstall new aluminum downspouts. ❑ 2 x 3 ❑ 3 x 4 QTY Color �
.? I
OTHER WORK TO BE DONE: �
,� • ;�,o�a/O�r/•e� . 20 �S co► ���k.���d�s���, �
' mat� ,�ia. io•o�.�,r�e��
- �I/ s� ZY G �rst Z y''oH C'e�tY -�.s�a/I ed ¢,y
�� Lrg��..,d��-Re�lec.k. T r p��r fS�,ir+t�e �o �'�+��.
WARRANTY: Contractor warrants that the Work will be free from defects caused by faulty workmanship according to standard
practices for a period of 10 years. Upon reasonable notice,Contractor will repair faulty work.
SEE REVERSE SIDE FOR IMPORTANT NOTICE
The Specifications,lob Cost,Payment Terms,Warranty and Other Terms and Conditions of this Proposal and Contract are
satisfactory and are hereby accepted by Customer. Contractor is authorized to do the work as specified. Payments will be made as
outlined above.
2 �
Homeowner Date ("nntrartnr rP
1. MECHANIC'S LIEN NOTICES. The OWNER aclaiowledges tha.t simultaneously with the executioi � �
• , agreement that the OWNER has received all written notices required under M.S.A. 514.011 (Notice of �
Intention to File Mechanic's Lien).
ATTEN'I'ION OWNERS
A. ANY PERSON OR COMPANY SUPPLYING LABOR OR MATERIALS FOR TffiS
IlViPROVEMENT TO YOUR PROPERTY MAY FILE A LIEN AGAINST YOUR PROPERTY
IF THAT PERSON OR COMPANY IS NOT PAID FOR THE CONTRIBUTIONS.
B. UNDER MINNESOTA LAW,YOU HAVE THE RIGHT TO PAY PERSONS WHO SUPPLIED
LABOR OR MATERIALS FOR TffiS IlVIPROVEMENT DIRECTLY AND DEDUCT THIS
AMOUNT FROM OUR CONTRACT PRICE; OR WHITHOLD THE AMOUNTS DUE THEM
FROM US UNTII, 120 DAYS AFTER THE COMPLETION OF THE IMPROVEMENT
UNLESS WE GIVE YOU A LIEN WAIVER SIGNED BY PERSONS W�iO SUPPLIED ANY
LABOR OR MATERIAL FOR THE IMPROVEMENT AND WHO GAVE YOU TIMELY
NO'I'ICE.
C. In the event it becomes necessary for the CONTRACTOR to file a Mechanic's Lien Sta.tement because
of non-payment by the OWNER of any sum required under ttus contract,then, and in that event,the
OWNER shall pay in addition to all sums required there under,the cost of the preparation and filing of
the Mechanic's Lien Statement,including reasonable attorney's fees in connection therewith,as well as
all other fees and costs allowed by sta.tute. TffiS SHALL BE CONSIDERED AS THE
CONTRACTOR'S TIlViELY NOTICE.
2. CHANGE ORDERS. The contracting parties must agree upon any deviation from the contract documents.
The signature or verbal agreement of one of the OWNERS or their agent shall be deemed sufficient acceptance
of the changes in the construction plans and specifications. Verbal change orders will be priced at time and
materials with materials and subcontractors billed at cost. Labor will be billed at$50 per hour.
3. ARBITRATION. All claims or disputes arising out of the building contract or the breach thereof shall be
decided by arbitration in accordance with the rules and procedures adopted by the American Arbitration
Association or the Better Business Bureau, as applicable. Initiation or use of arbitration proceedings by either
party shall in no way waive any rights of the CONTRACTOR to pursue remedies available under mechanic's
lien laws.
4. PRICE. The OWNER covenants and a�a�psytl��-�N'I'RACTOR for the executions of the conditions
stated above of said building in the sum of ,which sum shall be due and payable
� �
as follows: �� �`� � ��,y.� �
�
30% DOWN PAYMENT $
333�
70%UPON COMPLETION ACCORDING TO CONTRACT $
5. ENTIRE AGREEMENT. This is the entire agreement between the parties hereto relating to the subject matter
hereof,and there are no other agreements,representa.tions, sta.tements,promises,warranties,or consideration,
neither expressed nor implied,other than those expressly set forth herein. In entering into this agreement,
neither party has relied upon or been induced by any oral representations made or any information given by the
other party.
-� ---
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OWNER �,-F '� ��;�.F°-., � I I � ( �-� � Z
Dated:
Dated:
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� Dated:
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Page 2 of 2 ��
��,.- ea�nv���e I 11V01 C
FzreRroris„iac.
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2434 I-fillview Road UAT6 INV(xCE 9�
Moundsview MN 55112
� 763.783.3994 Fax:76�784-1895 6/19/2012 1371
Iance4019�gmail.com
' bainviileexteriors.com
�II.L T�O S[�F 1'O :
Reeg,David
1280 juno Ave
St Paul,MN 55116
,
P.O IV[J14ffiIIt 1�tMS `REP SIiiP VIA ' F.O.B. P'ROJECT `'
6/19/2012
` QUAN1'FI'1l " DESCRi!'TtON 1T�M CADE ' PRICE Et�CH AMOLTNT
1 Vytek Antique Ivory D4.5 and accessories V7NY[.SIDING 5,330.00 5,330.00
1 EA Window Wrap(SNI� 70.00 70.00
/
T��t �s,400 00