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VonDeLinde (2) � ' L)�kRRELL A.JENSEN STEVEN G.THORSON JEFFREY S.JOHNSON i / � ELIZABETH A.SCHADING RUSSELL H.CROWDER ; � �� WILLIAM E HUEFNER JON P.ERICKSON � � BRADLEY A.KLETSCHER THOMASP.MALONE DOUGLASJ.DEHN MICHAEL R HURLEY T KRISTI R.RILEY DOUGLAS G.SAUTER Barna, Guzy & Steffen, Lt�. WILL[AM D.SIEGEL HERMAN L.TALLE 7IMOTHY D.ERB CHARLES M.SEYKORA ATTORNEYS AT LAW KAREN K.KURTH DANIEL D.GANTER,�x. 400 Northtown Financial Plaza ANGELA M.WOESSNER BEVERLY K.DODGE ADRIEL B.VILLARREAL JAMES D.HOEFT 200 Coon Rapids Boulevard TAMMY J.SCHEMMEL *]OAN M.QUADE Minneapolis, MN 55433-5894 JOE M.WEARMOUTH SCOTT MBL PAKAN (763) 780-8500 FAX (763) 780-1777 SHELDON M.CLARK 1-800-422-3486 www.bgs.com oFCOUNSEL *Also Licensed in Wisconsin W.JAMES VOGL,JR Writer's Direct Line: (763) 783-5137 �������� E-Mail Address•: mjakacki@bgs.com �A� 2 ? 20�3 January 16, 2013 �"�'1��.;� Bv facsimile (651) 266-�574 and U.S. Mail City of St. Paul ATTN: SANDRA, RISK MGMT. 15 West Kellogg Boulevard 310 City Hall St. Faul; MN 55102 , RE: Our Client: Tyler VonDeLinde Our File No. 64068-001 Police Case No. 12-291-362 Date of Loss: 12-12-2012 Dear Sandra: Please be advised that Attorney Russell H. Crowder with this office has been retained to represent Tyler VonDeLinde in regard to the collection of damages arising from an automobile collision with a City of St. Paul plow truck. This collision was handled by the St. Paul Police ��:,�;�rt�:ent, case no.�12-�91-362. Please provide our office with information regarding the investigation into this claim. I have attached copies of the information submitted to you by our client on December 14, 2012. Sincerely, BARNA, ZY STEFFEN, LTD. � ( `� ��/ � � Mdilv . a cki Paraleg 1 Enc. An EOE/AA Employer Celebracing 75 Years of Legal Service I � � . ��������� � loSr Z(�(� d��� � . --��.� �, NOTICE OF CLAIM FO���`,�'�'�2����, e Ci��o�aint Paul, Minnesota �';�i�Ia `,'�..�-�i��v��; Minnesota State Statute 466.OS states that"...wery person...who claims dmna �;f��nicipaliry...shau cause to be prese�ted to the � goveming body of the municipal7ty within 180days after the alleged lo�`s b�t�ju rs discovered a notice stating the time,place,and � circumstances thereaf and the amouni of compen.urtion or orher relief dem�ded" � I Please compFete this form ia its entirety by clearIy typing or print3ng your answer to each qaestion. If more space is needed,attach a�ditional siieets. Mease note that you wiIl not be contacted by telephone to clarify answers,so provide as mach information as necessary to eaplain yocu claim,and tbe amount of compensa�ion being reqnested. You wIll receive a written aclmowledgement once your form is received. The process can take np to ten weelcs or Ionger depending on the nat�re of your claim. This form must be s3gned,and both pages completed. If something does not apply,write`N/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERI�, 15 WEST KELLOGG BLVD,31Q CITY HALL,SAINT PAUL,MN 55102 � First Name �e Middle initial�+Last Name t/oH �C �..���� , Company or Business Name_ f�/�{ ! Are You an Insurance Company? Yes I'p' If Yes,Claim Number? � Street Address Z06� aG:u'� 7`� � City `7sa:.!-f' ��l State� Zip Code'�� Daytime Phone���������Cell Phone��!��l Evening Telephon�_�?Z`�°3v Date of Accident/Injury or Date Discovered �Z • �Z• �L Time Z'� am� Please state,in detai2,what occurred(happened),and why you are submitting a claim.Please indicate why or how you � feel the City of Sa_i1n�t Paul or i ernployees are involved and/or responsible for your damages. �! d7ti.._�t�' _. Please check the box(es)that most close2y repzesent the reason far 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 i ❑My vehicie was wrongfully towed and/or iicketed �I was injured on City property �Other type of pmperty damage-please specify � �Other type of inj ury-please specify To - '�E'� ' �✓ _ In order to process your claim ou need to include co i of all a licable docame ts. { For the claims types listed below,please be sure to inclvde ihe documents indicated or it will deIay the handling of j your claim. Documents WILL NOT be retumed and become the property of the City. You aze encouraged to keep a i copy for yourself before submitting your claim form. �Property damage claims to a vehicle:two estimates for the repairs�Q your ve le if the damage exceeds $500.00;or the actual bil]s and/or receipts for the repairs �ivi� s�ZL"���� O Towing claims:legible copies of any ticket issued and a copy of the impound lot receipt �f�,Eo 1.t��� � O Other property damage claims:two repair estirnates if the damage exceeds$500.00;or tl} actual bills and/or receipts for the repairs;detailed list of damaged items � C �✓`�«mti..:�� O Injury claims:medical bills,receipts C�SL aY� ��'�-G��'`�'� O Photograpbs are always welcome to document and support your claim but will�5ot be returned. ; 6 I Page I of 2--Please complete and return both pages of Claim Form . � I I � . 1 I �ailure to coraplete and return both pages wlli cesult in delay in the handling of your claim. AIl CIaims-niease comalete t�is section Were there wimesses to the incident? � Yes No Unk�own (cixcle) � Provide their names,addresses and tel ho e numbers: � : • G4�L� �y✓G �{ . L�i e ;o e, ae, e ���.'7[aey Were the police or law enforcement ? Y o Unlaiown {circle) If yes,what depaitment or agency? ��Case#or report# �Z - Zg1 - 3�'Z Whene did ihe accident or injury take place? Provide st�eet address,cross street,intersection,name of park ox facility, � closest landmark1 etc. Please be detailed as possfb/�e. /If necess ,attach a d,�i am. ��A•'�+G �t n� �✓e�..ecc •..s.�/ ,C�.Q 3E ,�. � �•y'�' . �... Please indicate the amount you are seeking in compensation or what y�L would like the City to do to resolve this claim to your sa6sfaction �ik � � �6w� : aT �- ti'e .•J cG:� U-�'%°Lt r�C�,,r.��.'� �-�c�1:`d,� 1 f�-�.. a.,r� -� �+�.� , _ VehieIe Claims- lease eom lete this section ❑check box if this section does not a I � Your Vehicle: Year Make o • Model •�.� � �I License late Number State Color � •• + Registered Owner �-[, c �t,� � Driver of Vehicle '� .,r •�7: eu De L:..�-.�t, Area Damaged T e- City Vehicle: Year Make �ev.1 Model g�x� License Plate Number `�l�-�3 State�Color Driver of Vehicle(City Employee's Name) �r:�-- -� L�aK f Area Datnaged � In' Claims- lease com lete this secti 0 check box if thi section does not a 1 How,were you injured? �: diE., dc. -.-.l-�e.�. a - � .r.a v.�Le. . What (s)nf youz�body were jured? �.�1 1.0 .� 6 .a�.� � -� �.... :s/c o� . Have you soug medical treatment? , es No Planning to Seek Treatment(circle) When did you receive treatment? Z • 12 - ��� (provide date(s)) Name of Medical Provider s): � e s: - C+.)o�d� •a.�! C�' :4 ~ Address C�6+l��r ' eI w�oe1 ..� � � �.w Te hone Did you miss work s a result of your injury7 e No �- l�^ r •+-S When did you miss work? (provi@e date(s)) � Name of your Einplo er: �A► s..-:.�.' ✓o � Address 3ZZO s N.. ✓ Telephane �r71. ��. � Z � ❑Check here if you are attaching m re pages to tl�claim form. Number of additionai pages . I By signing this form,you are stating that ald information you have provided is true and correct to the best I of your knowledge. Urtsigned forms will not be processed �z - 15�. Lelz ` Submitting a false claim can result in prosecution. Date form was completed ' ----,�e..�. U ��L.��;• ��'�� � Print the Name of the Person who Complet "'' i � Signatnre of Person Mala.ng the CIatm: ! i • Revised February 2011 � i i i I i � ( f � " � _ 1 • , � . ` • . � . ii/1 /, ! � � s' ' �• �.� �. . • � ' • / �► I ...• / �_P � �L� -f� , �� / .� // ,�/ �_ � 1 L!/I • � � ,�'w , � ►Li�yr. .. . .// '. _ li '.' . . � ♦ . .i _ -� r � •� '�� �� •t i • �• • • i�� • • • •• • � � • �:. . . ._ . ._.._._. _..._...._ . _ _. . __._ - '� .. - � ,' ..• . • � •• �. . . . � _•_.,__� _. .������ __. . ., ���-. . . . .. .._. _ ......_ __._.__. ... ... .._. ._._. . � • • _ . . 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H��.Yt ry������41+�'�������,��,���A'�k d .. l4 � � ..-� � � ,�`'-h G�' ?a�J �ti��S�,�}k��.r '�rieS�e'`�'u'q �a"z4�x,�,�'�rz a �C��, y �. '' r�� ! �4 .�'t��'��'�a4 z k�S�r k .�- �x y'�i-y``s�t a M�t � f �l;. ± .ti� L,�„i. �+�t��q['�'•���,�rJat�^�-�,�'�' ` _�' '�' �i��� a�r .'?e'"e x ,�Y✓. � .. 1 � � � ;* �;f Q`_ - r µ4�. tF t a ^s. x�, e � , M �-,'�'i ��a. }1k�-��,�4'� �1r �t y. i � �i�4 ¢ 7-v i :- :it . -. t _ �� � .:,�f` �r ��s � '? :; '.,'', y'f.,, �.,_� ...,;_ l 5... . ,,::: �.. ?� � a ._..... __...�.. .._.._. � ...... ,.... . , . . .. .... .... .. . ... _. . i � . �.,_. i CITY OF SAINT PAUL ; DEPARTMENT OF POLICE � 36'7 Grove Street . � Saint Paul, MN 55101 � � `�'p IIL?0��'g � � 12 � 29' �-- 362 ' � Phone � ; �_ . f . t . � • - � 1 • � � f I i . , � � i � I f �' � Attachment to Notice of Claim Form—Tyler J.VonDeLinde The reason for my claim against the City of Saint Paul is due to a vehicle accident caused by an employee of the City of Saint Paul Public Works Department on the day of 12-12-12. I have suffered from multiple injuries, my dog (who was in the vehicle) was traumatized and taken to a veterinarian, my vehicle was damaged, and there was damage to personal property caused by the accident. I was driving home from my parents' house in Eagan with my dog and got onto White Bear Ave northbound from I-94 east. I was traveling north on White Bear Avenue and approached the intersection of Case Street. As I entered the intersection, a City of Saint Paul plow truck, coming from the opposite direction, turned directly in front of ine. I had the right of way; the truck driver did not. I locked up the brakes on my vehicle and skidded approximately 20 feet before colliding with the front of the plow truck. The light at the intersection was green. I was wearing my seat belt and it was a very hard impact and my head hit the steering wheel. My dog was thrown forward into the dashboard. The accident happened at approximafely 2:50 p.m. I called 911 and a City Police vehicle arrived on the scene about one minute later. The police officer talked to the plow truck driver and to a garbage truck driver who witnessed the incident. Those discussions went on for about 10 minutes before the police officer even spoke to me. While he was talking to the plow truck driver, and one of the witnesses, a paramedic arrived and asked if I was ok. I told him my head and neck hurt. I then spoke with the officer and told him what had happened. There were two other witnesses from the vehicle behind me who were telling the officer what happened. But,the officer did not take a report from them. I then asked th� offcer if the paramedics we:e pulling around the block to get out of the road cr if he could call another ambulance. Another ambulance arrived about 5 minutes later and I explained to them how my head, neck, back, and teeth hurt from the impact. They said my adrenaline was wearing off and that I probably had whiplash. They asked if I needed a ride to the hospital and I asked them what their opinion was. They didn't think an ambulance transport was necessary. They did not offer or make an effort to place a brace on my neck. I told them I would get a ride from my parents when they arrived. My parents, brother and girlfriend arrived shortly thereafter and I was driven to Woodwinds hospital in Maplewood. I was admitted as an outpatient in the Emergency Room at Woodwinds at approximately 5:00 p.m. I was examined by an ER physician,x-rays were taken, and I was released with a prescription for medications. On 12-13-12 I took my dog to a veterirarian for an evaluation. On the same day I also had my vehicle towed to Doherty's Auto Body Repair for an estimate of damages. That same afternoon I went to the dentist and had repairs done to my permanent retainer and x-rays of my teeth at the Northwood Dental Clinic in Eagan. On 12-14-2012 I went to a family physician and ophthalmologist at the Woodbury Allina Clinic for an examination. This report was submitted as an attachment to my Notice of Claim form delivered to the City of Saint Paul,City Clerk on 12-14-2012.