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Vang, Mee Minneapolis Office 12800 Industrial Park Blvd Douolas & Vande Ve te PLLC Su`te 2,0 � Plymouth,MN 55441-3929 Tel:(952)475-2219 PERSONAL INJURY LAWYERS Fax:(763)450-1555 Dean J. Dovo/as E-mail:arlo�dwlaw.com Arlo H. Vande Vegte* St. Paul Office 2015 Rice Street Suite 250 September 19,2012 St. Paul,MN 55113-6814 Tel:(651)488-2430 Fax:(651)488-2460 City Of St. Paul E-mail:dean�dwlaw.com City Clerk 310 City Hall �Reply to:Minneapolis O�ce 15 West Kellogg Blvd. St. Paul, MN 55102 O Reply to:St Pau/Office RE: Our Client: Mee Vang Your Insured: City of St. Paul Date of Loss: September 10, 2012 Dear Sir/Madam: Please be advised that this office has been retained to represent Mee Vang as a result of injuries sustained in the above-referenced automobile accident. A police report has been enclosed for your file along with the Notice of Claim Form completed by our client. We are in the process of investigating this matter and upon receipt of any documentation supporting this claim copies will be forwarded to you. At this time I would be interested in receiving the following information: 1. Name of the claim representative assigned to this file; 2. Claim number; and FINALLY, PLEASE CALL TO ARRANGE FOR AN ADJUSTER TO EXAMINE THE PROPERTY DAMAGE. If you have any questions or comments feel free to inquire. Very truly yours, DO L &VAN VEG , PLLC -.�.. � lo H. Vande Vegte AVV/jlh Enc. 'Board Certified as a Civil Trial Specialist by the Minnesota State Bar Association i � i� , _, - NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota Minnesota State Statute 466.05 states that " ...every person...who claims damages from any municipaliry...shall cause to 6e presented ro the governing bodv of the municipalitv within 180 davs after the alleged loss or injury is discovered a notice stating lhe time,place,and circumstances thereof and the amoun�af compensation or other relief demanded." Please complete this form in its entirety by ciearly typing or printing your answer to each question. [f more space is needed,attach additional sheets. Please note that you may or may not be contacted by telephone to discuss your claim circumstances,so provide as much information as necessary to explain your claim,and the amount of compensation being requested. 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 �eQ.. Middle Initial Last Name V C�YIQ _ _ Company or Business Name, if applicable Street Address � l 6� L�0�..1� � s T/�'�� � S�._LL���`,L� State m�NN�soT� Zip Code �51 � � CitY_____--,__ �= y..��.__ � � Daytime Telephone �_) �'�3�� � I � �'Evening Telephone (_, Date of Accident/Injury or Date Discovered O�I l�I�o[� Time � �a� am/ m (c cle)� Please state, in detail, what occurred, and why you are submitting a claim. Please indicate why or how you - feel the City of Saint Paul or iis employees are-involved and/or responsible. R� � �ex- '�r� -F U�I�e�� P a,n� �_b n�� 5�- �'1 cv Mo�e, �a J - —T—� � �,,�- '-�o . o � S i �t.�e ` �v iet-'t w h �Y'1�. � � �.e,re, w orv+t�-�1 � s-'ro a �� ��L� �.�e �'-�o �nc . �s S� d� � a��.Sltie, �, � � �o � �� a o cN�ss -�o s-�� vZ. sc�,v�r � '�CV.X' � dl -�`Co �E ���' .��:YY"e ' `-' S�o Q�'1�" �n,�� �:.�,c- cx.�c� e-?r' �X- C.�'-oss ��r`t'ee� �� ° �i!'e. - ;`3 s l�l;R.S Co�W-� � ��. Yv�� A�� Cx�0.S�/�.c� �:�(� Please check the bo�(es) that most closely represent the reason for completing this form: ''�Vehicle was damaged in an accident O Vehicle was damaged during a tow ❑ Vehicle was damaged by a pothole or condition of the street ❑ Vehicle was damaged by a plow ❑ Vehicle was wrongfully towed and/or ticketed ❑ Injured on City property ❑ Other type of property damage—please s ecify � ��,�, ' �-- . L/I. G� �.,., i ,a��. � .. .,.. -- � ,.. .�-`. . ❑ Other type not listed—please specify r �� ��`� ) 0.,� bY1 GJ�11. In order to process your claim vou need to include copies of all applicable documents. This is a g neral P guideline of what should be submitted with a claim form,but it is not all mclusive. You may be asked to provide additional information depending on your claim. O Property damage claims to a vehicle: at least two estimates for the repairs to your vehicle, or the actual bills and/or receipts for the repairs O Towing claims: legible copies of any tickets issued and copies of the impound lot receipts O Other property damage: repair estimates, detailed list of damaged items O Injury claims: medical bills, receipts O Photographs can be provided but will not be returned. Page 1 of 2—Please complete and return both pages of Claim Form Failure to provide a completed claim form will result in delays in �rocessing. � -�-�. ba.c� o-� m� c�-� �r� s p��� � ���1 �r-� � 1��fi - �_ bac.k- sr��e. m� c�r s�-�e�, c�ov�h� a� �0.� �ns-�����, � �1.. �s���n`�. ��o����'r -'ro m�s�� a� �h�. �rn� c�.v- s��p�a mo�i��1�_ cn� 1�e-�'r �r.e��� ct� d �r�m -�� S� o,��r��e� in�� �- dr;ver`s Cm� Si c�e� ��or. Z Co v.�� �t�`r o�C� -'�e, �vr s�n� � Co v.l�. r�o'c reA�\� ��-e ` '�� \�� � o��-�n, �T�e �-��e, -�-►9'��-e-�— ��� ���m ca.K�k- ol� �.� �, -��� c�,r�,c� G'h�L�- u f'1 `t�f\� G�X�c� S�e_ ,1� �- UJ G�S 61�-�-`�.. � � ��'��^-ev�n �-�� a a � �- .��_:�..�-�-�- -�.,�.o, te,-�� s�e.�_�� �rm �E� ��1 ���l� '�`�''�b � G�h c� �����v�,�. �h.e� S� wc�c� -'Cer�tm -�01 d Pr�e..�-o C�`��` 'My cx.�- n v e,r �o �r-�n�¢. �lno u, � �E l.�o�n�+r� �-'�=� �-��a -�� n� ���c.� -��-�;� . � �;��� �u-� �-u�, c.�- v����� ��- �,���.� ,��.� --�o �a �.e. -� �s��-� wti c�,v- a�� -�--,� -�-� �� o� ,� ���,� � , , `� �p `�°� , w h�c�n �. c�� � a�,� -�, c.s�.�c- �v��, s1o�� � � s�� �� � `�s �f�u�d�r �- �n�� s-�;�};C,,��,, � ' �xt���.ef �s o��,- -f;� f'd .r..L c��,� \l �a'� o �. p�� '�� °1�r;��e�- S'�de. do or � `Je-� ��-� c�,�d �ti^ct�.�1 e � -� -��,�, P�xe�� S� c�e --�� � � �._._.�'� ���'r`_�.._ �,�A.����.. ��c-�� ��� - - _ �h a �o �. - _ � rt, � C�c�'�+c- -�,N G�ey��v c�1 , ��1��`:�i;�c1 �a� `� � �� e� @ 3�.o t� P�n �o C�� ov�, v�ti�c,� �, ��ro-�-�..Qx, � , �-a, ac�� 11 a��, c�z�,a s�s�, �ex� �1a.n�� �'�- - � �.�� a no-t- ���v.� mv�.C5v1 ����s�1 v.��,�G� ��� �QS ���- �o � e �he- l�e�� � ��5��.�e. �ti.� �o���a �-eAr� ho.s c�� a �� � �'�� ��- �k,�c��. S- � OlS c���s�ari(L � �o �� �� � `�--�2� C�,�N� �c�,�`c1 , W�n\C.`1 � O ��e.e\ ������� �`� � 1(�c u,��,rtie:s S � c�,�c� ��v� -�� ��j 1e�F�Y \r.��� -�v -�� ,c,>�no v���esc- �o �P t� �c� --'�o �`� � \��'a�-m���. bv��a;�ce cc�e. �co �� ��-- ��oY�s ���P�-�� wti�c. ��� ca,�. ��o�� u�,�� �i`��, � � Notice of Claim Form, City of Saint Paut, page two . b�L �-o n-}• �F-�o�v -�'`�- All Claims— please complete this section � �x�'Y�o•Y1 VJ�b Ck't�� �'�L- Were there witnesses to the incident? Yes No Unknown (circle) S�ee�'. If yes, please provide their names, addresses and telephone numbe : Were the police or law enforcement called? es No Unknown (circle) If yes, what department or agency? ��v, �.�- �o;�n�' ���'� Case#or report# ��l -- a��a�b po\��� �� c-e.r� �, t'�1��-�n A,e� `���e,r S�-1�e�\ Where did the accident or in�ury take place? Provide street address, cross street, intersection, name of park or facility, closest landmark, etc. Please be as detailed as possible. If helpful, attach a di lgram. '���ex-��o� � w��\bc�� �IGw�r An � L ?�tri,et��►" s��'� Please indicate the amount you are seeking in compensation from this claim or what you would like the City to do to resolve this claim to your satisfaction. L !�(,F�h-� 7�j P �'�`�c./ !� �� U, � ��(/s� � �,/ �/'� ' � �'/S o ��I�.�// �a.� . Vehicle Claims please complete this section ❑ c��heel�box i�this section��"s rTO� V Your Vehicle: Year�`�Make Model License Plate Number �/ gS State� olor G u Registered Owner �1 Driver of Vehicle � . Area Damaged ��x' SQ-C._�-�bn �� w� 17C� � � � -L 1`Q� S� � City Vehicle: Year Make Model F 1r2.����t— �u.�-�- �1�0.c� License Plate Number State Color '�C't.lC t�� � Driver of Vehicle (City Employee's Name) Area Damaged In'u Claims— lease com lete this section ❑ check box if this section does not a 1 How were you injured? �4� � h�. {`(� 'F s ' e � �r� \i ` v What part(s) of your body were injured? C� �l,.� _ � h'�`S Have you sought medical treatment? es No Planning to Seek Treatment (circle��� I.vF When did you receive treatment? O� ��(Af 'Zp�.Z ' (provide date(sj) �n�l� � Name of Medical Provider(s): Q � t\ d 'S , Tele ho ^-2 — � Did you miss work as a result of your injury? es N ' ' 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 BV signing this jorm,you are stating that a!(information you have prnvided is true an�l correcl to the besl of your knowledge. Unsigned forms wi!! noi be processed Submitting a false ctain:can resu[t in prosecution. Print the Name of the Person who Completed this Form: Signature of Person Making the Claim: � Date form was completed ��f� I 7-�I Z Revised April 2007 � � . rl..._- �-� - ------- - - .-� - - ._. . .� ...,_ .� .._ �_ �__� _. - �, n - �a,��• ���.��..�. -- -. -_�_. - � � \� Page I of 1 'Aecident Report � i ���. � � � 1221720b � ,.a � rn�ronw wsRav veaa�s pum s�a+ 9 �Q 2012°�10A 1519 m' Tf 'N �2 d0 �1 ' 1� o aou�arsro+ aartaMS�ereaeem�srwwe ' , K°�� ���-,• aa Q� $a 8w a�r . � . s w .r ....� r.., 10 • L'Orien� � ,e�rtssr, NanEa oonruu+.aereana� �"° ' "'�" 10 Wheelock 52 �,wP St. Paul + • surc a,3s c�sn�nre r,�yroR, ,�,�, vos�an oa.�u�w.�xa su.e wss s►�.a rom� ciuueavee�ae,u�•: � D pl ul 01 n814191021813 MN b Ol 01 s399129201221 oaEOCw+m �_ F,�+o�: w�earo*woaE.va� aueoFer� wv+EV��r.u�sn 11 23 'I3 • David Wegwerth 04 2 59 NfEE VANG � °" �� 06 ""�" '°°"�' N., Oz 1965 LORIENT ST �7 ��' 06 645 Randolph g+*� cmcsT"�'D° 5517937549 01 � °t'�` "'L' 651776125� ST PAUL 55117 01 St. Paul 55102 ' � � M . �9 ,,,� 4 � 05 � � F '�Q �04 04 05 �C O1� - O 1 ^`�.� a�"'""s* �yp1� IVPE OfiVO TNL 1Df106p 1WiKSAORT At61RIHCSSfRVICi RINtM�O�R KCH. iVDi 0lOJ6 7Y� iOMDSP 7fVWSPM't A161fAt�� '� 98 �: 9� N-- a�, �, 98 1�,' 98 Yf p�„ spp� 22 r� om,. ' � mm owr+aew�c I� 0�` � °""�""""� ; �i MOUA BEE ' ' p�, Cf�y of st. paul� �- 03m w+n► � �5 LORIENT ST � gp �45 Randolph � ��* �� vs�use u,xewe� wu.a arecr cmc�u�eso 05 O1 49 St. Paul, MN 55109 � 05 ST PAUI� MN 55117 �� �— � wKC "g�p� gg LVD 06 oi � � Zoi a � x�A � ��o ,�� sruo v�aato �a�aestvnrts �. e�en .u�. M^ "�`°'� '°""' 01 �3�" °"°°E" r`R" "'" "m° „'° �°"� '� vuv859 MN 13 O1 02 s pd mn 3 O1 ,�„�„� POUGYI7U�£R 03tAANfSM1Nr7S . �"""�'� i farm bureau proper'ty �i�����a�ty city of st. paul E ,,,�, �wR � G� wtz�ra xv��o t+�cna�+ rsae+ooes IFACCiDE1�iTINYQLVEDACON/JERCW.#IDTORYEiIiCLE.BC#IOOlB1iS.OR1IEADSTARTBUS 7 � � mc �4 .� REMEItBEIt TO HQTIFY TME 87ATE PATROL(requtnd ondor1R.4189.18J snd 189Abt1J. ' �yyext6�n�uaa2•waoaeMaat� ootMSe�t �o�a�eaiaw�aErawevc�.�+oroac�ue�twws ooT�ae�rt �rrnm�ssaa ' uwr m a�zoc sx rne uc ,wmw �e► waev roHOev taur�ac* �� �� � w. � ' °°"e` . ' ,� ,�.� a"'M"�" � � � °�„� ,�� b"� . 9�.� � : o�„p, ������� � wArncton��+ou,woEOSa�f1+TM�ionESamaxoFO,wAaEOmooEm+ruraaR�tcvntNOn�M�1 i t oE+att POGM w�nan�. ..... .........__...._ 03 O1 ..__..__..............._... ......... ____......_._.......... �,.,e,,, Unit S2 was mak3ng.a left tuYn,onto L'Orient . ..... .. Street�from Wheelock Parkway. Un3t���1 was behia �,�„ �,TM � I .unit.i2.._.Unit.�kl.s.topged..at..zt�e...stop.s.i.4n..._2.o.ak� O1 N*�°�' � both ways, all was safe and uait �l Px�eeded M� a+er000s o � -in�o�•�he in�erseet4on.....�1,...woman on••�he-cosae�w.. 04 � not looking, ran in front of unit 82. Uni.t #2 N' r � . � "sla�inisad..�n'h��r°brakes"�nd cam�"'t�°a'sudderc'seo�.' � rsEO�wL � .... .._.. 1. ; Dni:t O1 then rear ended unit #2._„ The 8river oE ...._....__.. .. 98 —� unit �2 was taken��to�Fteg�.ons�Hospi.ta2�by�Nled c ��t .�22.. .....,..........••-_........._...._........ `c��wr .... ........... , . _............... � __ _� � � � �1 { .._...._........ .... ..... ��: � � _ ..............__ ..... ................ .............._ = t'OrientStr�et .. .. ......... ................. . .._..._....... ......._...... ._...,..._:.._ T 1 t ,ro�«, . .. ..... .. .... ....... _.......... �..._...._....__...... 05 ` � ... .................. .O1 �n� � i .. ..... . ......... ..... w� . .. . .._... ,.. ... � .� ......_...._... O1 . . .. ....�..._..._... _.. .._. .... y • ...................._ .._.... � � ,roa.w . . . ....., .. ........... .. ..... .. .._... ..................................... O1 � Ol - �r ,n„ []saa�,uaa � . �,w,K,uu��woe�e. � ��� St Paul PD ��l O� O p1�" officer Micha�l Dollerschell 615 � • www.dvsiesu ort.org/dvsinfo/accidentrecords 2008/Includes LEIPrintDVSReportlndiv_LE.asp?... 9/11l2012 https.// I�P ' Saint Pau! Police Department pa9e 1 of 5 ORIGINAL tJFFENSE / INCIDENT REPORT Complaint Number f2eference CN Date and Time of Report 12217206 09/11/2012 07:40:00 Primary offense: TRAFFIC ACCIDENT-PERSC)NAL iNJURY Primary Reporting Officer. Dolisrschell, Michaet R Nama of location/busfness: Primarysquad: 25� Locatronoflncldent:LORIENT ST 8�WHEELOCK Secondary reporting officer MN 55101 Approver. Gr�hgk, JOn DistricY. Central Date&time ofoccurrence: 09/10/2012 15:14:00 to site: 09/10J2012 15:14:00 Arrest made: Secondary offense: Police OfficerAssaulfed orinjured: Police O�cerAssfsted Suicfde: Crime SceRe Processed:YeS OFFENSE DETAl1.S TRAFFIC ACCIDEN7-F'ERSONAL INJURY Aftempt Only: Appears fo be Gang Related: Crime Scene Method 8 Point of Eniry Type: Gov/publiC property Force used: Nid Inside: Desc»ption: Point of entry.- Method: Victirns Vang, Mee NAMES Driver Wegwerth, David 645 RANDOLPH ST ST PAUL, MN 55104 Nicknames orAliases Nick Name: Alias: AKA First Name: RKA Lasf Name: Details seX. Male Race: �ite DoB: 4/28/1959 Residenr Status: Hispanic: Age: 53 from to SP30'1568F76460F Pa9� 2 of 5 � Saint Paul Poiice Department OR1GiNAL {JFFENSE ! tNC1DENT REPORT Comp7aint 1Vumber Reference CN Dafe and Time of Report 12217206 09/11/20 9 2 07:40:Ofl Primary offense: TRAFFIC ACCIDENT-PERSONAL INJURY Pha»es xome: Cel1: Contact: 651-776-1252 Work: Fax: Pager. Emp/oyment Qccupation: Employer. ldentificairan SSN: License orlD#: License Stafe: Suspect UNKNOWN Nicknames or Aliases Nick Name: Alias: AKA First Name: AKA Lasf Name: Details Sex: Race: DOB: Resident Sfatus: Hispanic: Age: from fo Phones Nome: Cef1: Coniact: Work: Fax: Pager: Employment Occupation: Employer. ldenfifcaflon SSN.• Lfcense orlD#: License Stafe: Physica!Description US: Metric: � Height: to Buitd: NairLength: NairColor. Weighf: to Skrn: FacialHair. Hair7ypa: Teeth: Eye Color Blood Type: SP301568F76460F � Saint Paul Police Department Pa�e 3 of 5 ORIGINAL OFFENSE 1 INCIDENT REPORT Complaint Number Reference CN Date and Trme of Report 12217206 49111/2012 07:40:00 Primary offense: TRAFFIC ACCI�ENT-PERSONAL INJURY 4ffenderinformaflon Arrested: Purserit engaged: Violafed Restraining Order. DUI: f?esisiance encountered.• Condition: Taken to healfh care facility: MedicaJ release obtained: Victim Vang, Mee '1465 LORIENT ST ST PAUL, MN 55147 Nicknames orAliases Nick Name: Alias: AKA First Name: AKA Last Name: Deta/ls sex: Fema(e Race: Asian ooB: 11/23/1973 Residenf Stafus: Hispanic: Age: 38 from fo Phones Home: Ce11:651-793-7549 Contact: Work: Fax: Pager.• Employment Occupation: Employer. ldentificafion SSN.� License or 1D#: License State: Fhysfcal Descrrpfio» US: Np Mefric: Np Height: to Bui1d: Hair Length: Hair Color.• Weighf: to Skin: Facla!Nafr. Nair Type: Teeth: Eye Color. 8tood Type: V/ctlm informatfon TYpe� (ndividual Can ldentify Offender. Np �Ifing fo Press Charges: NO Condition: Taken to heaJth care facility: Np Medicaf release obtained: NO SP301588F76460F � Saint Paui Police Department Pa�� 4 of5 ORIGINAL 4FFENSE / INCiDENT REPORT Complainf Number Reference CN Date and Time of Report 12217206 09/1'I/2012 07:40:00 Arimary offense: TRAFFlC ACCIDENT-PERSONAL lNJURY SOLVABILITY FACTORS Suspect can be Ident�ed.• By, Photos Taken: YgS Stolen Property Traceable: Evidence Tumed!n: Property Tumed!n: Related Incldenh Lab SiologicalAnaJysis: Fingerprinfs Taken: Narcotic Analysls: ltems Fingerprinfed: Lab Comments: VEHICLE INFORMATION (Information f3nly) Registered owner. Vang Mee , Status Description status: Other ucenseno.: VUV859 Year. �ggg Towed: State: J�N rype: Sports utility vehicle Owner. Varlg, Mee Year.• g/20�z Cotor. Gfay Stolen Mefhod.• V.l.N.: Doors: Lock sfatus Make: Kjg Transmisslon: Keys In vehlcle: Mode1.• SPORTAGE Shift Position: Mileage: Vehlcle Damage DRlVER'S SIDE REAR Registered owner.� Wegwerth, �avid Status Descriptlo» Sfatus: License no.: SPFD Year. Towed.• State: MN Type: Owner. �JegW��{�, David Year. Cotor.• Red Stolen Method: V.1.N.: Doors Lock status Make: Transmfssion: Keys In vehfcle: Model.� Shift Position: Mileage: Vehfcle Damage SCRATCH ON FRONT BUMPER SP301588F78460F - Saint Paul Police Department Page � of 5 QRIGINAL �FFENSE / fNCIDENT REPORT Complaint Number Reference CN Date and Time o€Report 12217206 09/1 'i/2012 07:40:00 Primary offense: TRAFFIC ACCIDENT-PERSONAL [NJURY Participants: Person Type: Name: Address: Phone: Driver Wegwerth, David 645 RANDOLPH ST ST PAUL, MN 551 Q4 Suspect Victim Vang, Mee 9465 LOR1ENi ST ST PAUL, MN 55117 NARRATIVE 4n 09-10-12 at 1514 hours, I (Officer pollerschell) was sent ta L'Orient and Wheelack regarding an accident involving a#ire truck. When I arrived, the driver of unit#2 (Mee Vang}was being attended to by medic#22. Medic#22 then transported Vang to Regions Hospital. I spoke ta the driver of unit#1 (David Wegwerth). Wegwerth was an employee of the St. Paul Fire Department. Wegwerth said unit#2 was stopped at the sfop sign at Whee�ock and L'4rient. Wegwerth said unit#2 started to turn left onfo L'Orient. Wegwerth said he then stopped at the stopsign, Eooked#o his right and started to slowly turn left also. Wegwarth said unit#2 stopped suddenly far a woman who ran into the street. Wegwerth said he then hit the brakes and hit the driver's side rear end of unit#2. Mee Vang's brother(Faidang Vang, 65'i-399-739�) arrived. Faidang said he wanfed Mee Vang's vehicle towed to her address. I called for Rapid towing and Rapid towing towed Vang's vehicle to her residence. There was a smafl scratch to Rescue Squad#1 and moderate damage to unit#2. See State Acc'sdent Repor�for more information. i took several photographs of the damage to both vehicles. The photographs were downloaded to the media vault. PUBLiC NARRATIVE On 09-10-12 at 1514 hours, pofice responded to L'Orient and Wheeiock for an accident. SP301568F76460F