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Obang i�E�El��C� ' ' �'''- � 22012 NOTICE OF CLAIM FORM to the City of Saint Paul, ��}�e�+qta �• 1 �•�.� t�•. Misi�7esota State Statttte 466.05 stales thcu "...ererl•person...�ti°ho clain2,s dnmages fi•om an�•�nuriicipality...shall cause to be presented to tFie � gorerning hoct)�of tlae rnienieiperlitt'���ithiii 180 dcn�s after the alleged loss or i�cjiu_�•is discoi�ered a notice st�ting tFte time,pface,n�id I circirntstances thereof;nsad tlze amouiat of cor����ensation or other relief dentnncled." 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. Ptease 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�rill 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 � l���t,� Middle Initial �Last Name �,�Gt �l 4 Company or Business Name Are You an Insurance Company? Yes/� If Yes, Claim Number? Street Address �'��4 z- � .S�"�� `� � City C` �tl�n� "Q �Q_c��,�_State,�/4� Zip Code t c�l-2/ Daytime Phone (�)�'.��,(�.°l.�Cell Phone (�1��-�� Evening Telephone(��)�� /��Z2- Date of Accident/Injury ar Date Discovered � �� ���� Time l° ��pm Please state, in detail, what occurred(happened), and why you are submittinb a claim.Please indicate why or how you feel the City of Saint Paul or its employees are involved andlor responsible for your damages. -� � �-�, e �e� � e � C� ��o��-.� Please check the box(es)that most closely represent the reason for completinQ this form: ❑ My vehicle was dama�ed in an accident ❑ My vehicle was damaged durin�a tow ❑ My vehicle was dama�ed 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 injuced on City property ❑ Other type ofi property damage-please specify ❑ Other type of injury-please specify In order to process your claim ��ou need to include copies of all apnlicable documents. For the claims types listed below, please be si�re 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 encoucaged 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 issuFd and a copy of the impound lot receipt O Other�property dama�e claims: two repair estimates if the damage e�xceeds $500.00; or the aetl�al bills � and/or receipts for the repairs;detailed list of damaged items O Injury claims: medical bills, receipts O Photographs are always welco�ne to document and support your claim but will not be returnecl. Page 1 of 2-Please complete and return both pages of Claim Form Y ' J � � I Failure to complete and return both pages will result in delay in the handling of your claim. ', All Claims—please comnlete this section ��, Were there witnesses to the incident? Yes �� Unkn wn (circle) �, Provide their names, addresses and telephone numbers: � Were the police or law enforcement caIled? � , No Unknown (circle) If yes, what department or agency? r�.Qt�U^,,.1�`�; �P�G.� Case#or report#�,2..0��°/`7 S Where did the accident or injury take place? Provide street address,cross street, intersection, name of park or facility, closest landmark, etc. Please be as detailed as possible. If necessary, attach a dia�ram. ,t-t�_P � �t,�JC.� Scfo�� - St-f� 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. � q���e�' ;wst ,�Q a'-o � -�-� �ti ¢—�� o' � �S i s (�..1�,..a,w �F--_� !,.']�r.A .Q.o o a � . � \ .-,zs2TT �_s r a .p� - Vehicle Claims please complete this section ❑ check box if this section does not applv Your Vehicle: Year��Make �o-kc�_ Model �- L��--�-� License Plate Number �H.'P��,-� State,�_Color A�_�e o �t�— Registered Owner�,��t.�(�h� a� �. C'� � Driver of Vehicle Area Damaged � City Vehicle: Year Make Model License Plate Number State Color Driver of Vehicle(City Employee's Name) Area Damaged � injurv Claims please comulete this section � check�ox if this sect�on do?s not apAly . 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 yoLi 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 signing this form,yoai �cre stating that czll information you have provided is true and eorrect to the best of your knowledge. Unsigned forms will rzot be proeessed. Subntitting c�false cic�int can resa�lt in prosecution. Date form was completed �_���.�5'����� � � �, Print the Name of the Person who Completed this Form: Q�4a�I�i��-t�-�—� Signature of Person Making the Claim: � Revised Fe-bruary 2011 Ojullu Obang 4404 2 I/2 St. N.E Columbia Heights, MN 55421 612-245-6691 Case#12095975 This claim is regarding to my 1997 Honda Accord that was stolen at my property in Columbia Heights on May 6th, 2012. 1 filled the `Stolen Car' report to Columbia Heights police (case#12095975). On May 7`h, 2012 citation (ticket) issued to the car because according to the citation it was park on a private property. The police failed to check why the car was parked in the place. If police would have ran the VIN# she/he would have found that my car was reported stolen. On the same day May 7th, 2012 St. Paul police called the towing company, and again the police failed one more time to identify that my car was reported stolen. On my 29�", 2012 I got the notice from St. Paul district court to appear in front of a judge because I failed to pay the citation. This was the only time I realized that my car was in the hand of St. Paul police. So, I called St. Paul district court asking them that why they sent me a ticket for the car that was reported stolen. Why the police failed to identify the car that stolen. On June 1 S`, 2012 I talk to the St. Police dispatcher (phone#651-291-1111) and she was able to tell me that my car was wrongfully towed on May 7t�', 2012. In the same day I want to claim my car from the towing company which charges me $455.30. My insurance won't re-inverse me. So, I talk to hearing officer who gave me information to claim back my $455.30. I would like city of St. Paul to inverse me as St. Paul police wrongfully towed my car without identifying it that the car was reported stolen. Thanks, Ojullu Obang � _ —� , i L U T H E R � ( ' Luther Towing & Service, Inc. � '�y� , W 1 N G��� � 1217 Frost Ave. ORDER NO. '-�'`-�� ��f� I 6,z-a4z-6o4B ,�, �= Maplewood, MN 55109 � � www.luthertowingservice.com (651) 788-9005 NAME -(�- � h P.O.NUMBER R.O.NUMBER ' \ I��_ 1 ' :a(� '.`j' '`-.I � ADDRES� _ . DATE�° ' � TIME DRNER ;,r. I �l.t . �C.f i' rf �l�- ,�c%s ��_''� �7 i �t. � ,. � � , TOWED---r � I i.._ .;�,. }" �`'7-�....'` 1�'��..1 ►��"'�� L FROM ' � { �' - �- i `.v. . 'i PHONE TOWED�__ � i Tp � t , ! i ! MAKE - �(.t?�. YEAR" ..-. C�LOR �P,LA E#._�+ ._ VEHICL� _�_.�; , L_ r, --� " MODEL ;c, �(;� t � � rr , �, ,, t�_ '; �� �'� OWNER E.�t,.- E 1 `�.�,�':1 j � VIN. _ . _ Y / ORDERED BY ; _ � TOWING � NO. "sT `�Yx',b ti'V, t.� } -i �'. , i • � ;r"' � - VEHICLE Yes Nc� ick-up J �} 4\ �r- � � MILEAGE ` KEYS Q - ❑ IMPOUND �? !`-,.` " I ENROUTE NOTES;s;, -- I MILES ,: d �_.. 'J�;, ; DOLLY ; LOADED . ' ' MILES �- � �S,?�1....-_;:. -� STORAGE �:, �' ��i,-' -i; : E�,y-�- WINCH OUT �'� ' ' LOCKOUT/FLAT/ . By signing below I authorize the charges listed and agree to JUMP START j the terms listed here. Luther Towing and its employees are z�° Tow � not res onsible for dama e due to excessive rust, MILEAGE P modifications or circumstances beyond our control. oTHeR FEEs � Si natur� � , .�• , , ,��, Tp� � � �. �. ` � � � r , , _.- i ���:����' PLATES ONLY ❑ VEHICLE THEFT REPORT CASE# 12095975 Both? ❑ Second plate removed? ❑ ANOKA COUNTY 1��x: 1997 MAKE: HONDA MoDEL: ACCORD EX viN: 1HGCD5658VA120701 PLATE: GPW102 TAB/R12 YEAR: STA�: MN COLOR:GRN #DOORS: 4 EST ODOMETER:143,000 EST VALUE:$2000 IDENTIFYING N/A CHARACTERISTICS &OTHER EQUIPMENT PERSONAL N/A PROPERTY Include make,model,serial #if possible FINANCIAL DATA IN VEH? ❑YES �NO IF SO,WHAT KIND?N/A OWNER: OBANG,OJULLU ANWEY DoB:12/19/1972 AnnxESS:4404 2'/2 ST NE,COLUMBIA HEIGHTS, MN 55421 Ho��763-354-6522 CEr.L#612-245-6691 woxx� PERSON REPORTING DOB: If oumer,check box � ADDRESS: RELATION TO OWNER: HOME# CELL# �'�'0�� LAST KNOWN SAFE TIME VEHICLE WAS DATE OF THEFT:05/06/2012 0000 Hrs to 1100 Hrs PARKED AT: 4404 2 1/z ST NE WHERE WAS DRIVEWAY STREET ALLEY GARAGE YARD PARKING VEHICLE APARTMENT COMPLEX❑ THE VEHICLE � � � � � LOT � SALES LOT Is it possible the vehide was PARKED? ❑ towed? YES❑NO� WAS VEHICLE WERE KEYS IN YES ❑ IF YES,WHERE?N/A LOCKED? VEHICLE? NO � YES� NO❑ WAS VEHICLE ANTI-THEFT VEHICLE WILL OWNER VEHICLE TRACKING? RUNNING? DEVICES? ALARMED? PROSECUTE (GPS/LOJACK/ONSTAR) YES❑ NO� YES❑ NO� YES QNO� YES� NOQ YES❑ NO� WHERE WAS OWNER/ WAS THE THEFT YES ❑ REPORTEE AT TIME OF THEFT? HOME DOMESTIC RELATED? NO� EVIDENCE OF METHOD OF YES ❑ IF YES,WHAT? N/A BREAK IN? NO � WAS ANYONE ALLOWED YES ❑ WHO?UNDER N/A TO USE THE VEHICLE? NO � WHAT CONDITIONS? YES❑ �O/REASON N/A SUSPECTS? N� � FOR SUSPICION? DOES SUSPECT HAVE KEYS FOR THE VEHICLE? YES❑NO� VEHICLE INSURED YES❑ AGENT/ LIBERT'Y MUTUAL PHONE# FOR THEFT? NO � COMPANY: SECURITY YES ❑ �TH WHOM?N/A CURREN NO ❑ AGREEMENT? NO � *************************INTENTIONAL FALSE REPORTING IS A CRIME*****"***""'`**""**"`**"`* ***1 HEREBY CERTIFY THAT THE INFORMATION I X PROVIDED IS TRUE AND CORRECT*�* REPOR�rnvG PERSON's SicNA�r[JxE OFFICER:MONBERG BADGE#117 DATE:05/06/2012 TIME:1940 Columbia Heights Police Department Supplementary Investigation Report June 5, 2012 Case#: 12095975 Offense: Vehicle theft Grid: 10 Complainant: Obang, Ojillu Address: 4404 2 '/2 Street Officer's Name: Sturdevant � On 5-31-12 the vehicle owner called me and told me that he noted that this stolen vehicle has different license plates on it then may be listed. He told me that the responding officer wanted the license plate number that would be listed on the title of the vehicle, which wasC�l„�,,.LQ2. He told me that he realized that those plates are somewhere in his garage as they expired and the new plates, SHP 843 are on the car. �^ I had dispatch change the listed license plate to reflect that MN lic. Plate SHP 843 was on the vehicle. Nothing further. Columbia Heights Police Department Supplementary Investigation Report 06/O1/2012, 1205 Case#: 12095975 Grid: Offense: VEHICLE THEFT Complainant: OBANG, OJILLU ANWEY Address: 4404 2 '/ ST NE Officer's Name: B. O'BRIEN On OS/31/2012, 1635 hours, I received a phone call from Ojillu referencing a citation he received on his vehicle he had reported as stolen. I asked him to fax me a copy and I would look into it. 06/O1/2012, 0900, in looking at his ticket I saw that he received the citation on OS/06/2012, 1000 hours and had reported his vehicle stolen at OS/06/2012, 1100. I called the Ramsey County Court number 651- 266-9696, to see if we could come to a solution regarding the ticket using our stolen report so Ojillu would not have to go to court as his ticket was already past due. Ojillu had already made an appointment to talk with a Ramsey County Hearing Officer and the Court Administrator said the Hearing Officer was the only one who could address the ticket;but to advise Ojillu bringing his vehicle theft report with to the hearing. When I called Ojillu back, to tell him he had to go to the court hearing and to bring a copy of his vehicle theft report, Ojillu stated he had found his vehicle by calling the office that issued the citation. His was told his vehicle had been towed off private property on OS/07/2012,by Luther Towing, 651-788-9005. Ojillu asked the tow company of the St Paul PD didn't know this was a stolen vehicle. In reviewing the vehicle theft report I noticed the MN Lic#of GPW 102 was listed on the report and the citation had a MN Lic#of SHP843. In checking further, I found that Officer Sturdevant contacted Central Comm and requested the license plate number be changed to SHP843. On OS/31/2012 at 0726 hrs � When I asked Ojillu about that he said he came into our office to pick up a copy of his report. Ojillu said his renewal for vehicle license had come in the mail. He was looking at it and noticed that the license plate was a different one than on his title, therefore the plate on the Vehicle Theft report was incorrect. I called Luther towing to confirm the vehicle was in their lot. Keaton confirmed they had the vehicle MN LIC# SHP843 in their lot,towed off private property. Keaton said he ran the vehicle a couple times and it came back clear. Luther Towing had already had a conversation with Ojillu Obang on recovering his vehicle. I called Central Comm and requested the vehicle be removed from stolen status. In printing the vehicle cancel from Central, I found that St Paul PD had gone to Luther tow and confirmed that the vehicle was there and sent a YQ. Central sent them back a YR confirmation the vehicle was still stolen status and removed the vehicle from stolen status. End of supplement. Minnesota 2nd Judicial District ��:,,�; `�•.•.6KOt��.�. � Ramsey County 15 W Kellogg Blvd Room 130 .,� : Saint Paui MN 55102 `' Phone: (651) 266-9202 '•- -- " Return This Portion With Your Payment �*1�i8��• ��p - �c��- � Cn�� ������I����������������������N�����������u�������������������������� AMATH UMOT GILO CitationNo(s): 620900508592 4404 2HLF ST NE, Plate No.: MN SHP843 COL HGTS, MN 55421 Vehicle Make: HONDA Pay Before: 06/27/2012 Balance Due: $38.00 Date of Notice: 05/30/2012 Amount Enclosed: ;�_ - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Late Payment Advisory and Final Demand Notice A citation for Stop/stand/park vehicle on private property of any person w/o consent of such property owner in Ramsey County at 719 NEVADA AV E was issued to you, or a vehicle registered in your name on 05/07/12 at 10:40AM. This citation has not been responded to within the required 21 days. A$5.00 late fee has been added to the balance due. If the citation is not paid before 06/27/2012 and you do not appear to contest the violation, a $25.00 delinquent fee will be added to the balance due. Under Minnesota statute 480.15 subd 10c, the District Court may refer any portion of the fine, surcharge, court costs, or fee that you fail to pay by the due date to a collection agency. Additional collections efforts that may occur are: � Refer your account to a private collection agency + Offset of your state tax refund ♦ Tow your vehicle � Recommend your driver's license be suspended + Access non-public government data on you for the purpose of collecting this debt - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - + To contest a citation or referral to collections, you must make an appointment to see a hearing officer. Appointments can be made by calling 6�1=Z��=JZU� —-- - - - — - — - ♦ You m�st bring this notice and a photo ID with you when you appear for your appointment. ♦ Make checks payable to Ramsey District Court. Write the citation number on your check and mail it with the top section of this notice in the enclosed envelope. ', � Do not send cash. � Please allow 5 business days for processing. t To pay by phone with a major credit card call 651-266-9202. Have this notice with you when you call. � Pay on the internet with a check or credit card. www.2ndwebpay.courts.state.mn.us If you believe this notice has been sent to you in error please call 651-266-9202. This is Your Final and Only Notice For your records: Citation #: 620900508592 , Offense Date: 05/07/12, Amount Due: $38.00 i-__ _- - - -- -- -- -._ ..k„�