Dubriel NOTICE OF CLAIIV� FORM to the City of Saint Paul, Minnesota
Minnesota State Statute 466.05 states that "...every person...who claims damages from ciny municipaliry...shall cause to be presented to the
governing body of the municipality within I80 days after the alleged loss or injury 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 acl�o�ledgement 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 dces not apply,write`N/A'.
SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK,
15 WEST KELL.OGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102
First Name �k r-------,--- _ Middle Initial � Last Name ����K �P �
Company or Business Name �'�`7 d� 'S�• ���'�' `
Are You an Insurance Company? Yes/No If Yes,Claim Number?
Street Address ��G O s�/�� ST •
City �� • vJ� / State �~ Zip Code S—�/U�
Daytime Phone(��) Z" �`��Cell Phone(� 3y���Evening Telephone `( S/ )�X �S�
Date of Accidend Injury or Date Discovered o�'1�'�3 Time 7 ��� m
Please state,in detail, what occuned(happened),and why you are submitting a claim.Please indicate why or how you
feel t`'hs�ty�of$aic�Paul or i s employees are involved and/or responsible for your damages.
_�,
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
�M❑ y vehicle was damaged by a pothole or condition of the street � My vehic}e was damaged by a plow
y vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property
O Other type of property damage—please specify
❑ Other type of injury—please specify •
In order to process your claim vou need to include copies of all apnlicable 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 are encouraged to keep a
copy for yourself before submitting yoar 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 tiills and/or receipts for the repairs .
�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 aze 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 No Unknown (circle)
Provide their names,addresses and telephone numbers: •
Were the police or law enforcement called? Yes No Unlrnown (circle)
. ff yes,what department or agency? Case#or report#
� � . . ,
Where did the accident or injury take place? Provide street address,cross street, intersecdon,name of park or facility,
closes landmazk etc lease be as detailed as ossible. If ne essa}y,atta a diagram.
�er` �
Please indicate the amount you seeking in compensation or�t you would like the City to do to resolve this claim
to your satisfaction. � .2 . O �/�'!-� %otv G C�r �°.
�" n
Vehicle Claims— lease com lete this section ❑check box if this section does not a 1
Your Vehicle: Yeaz Make Model G�ri}'S ,
License Plate Number �t' �f'� �tate IiNN�olor f3rou!^
Registered Owner ru 4 BrGioo
Driver of Vehicle �w ''"' '�
Area Damaged ,
� City Vehicle: Year Make Model
License Plate Number State Color
Driver of Vehicle(City Employee's Name)
Area Damaged
In'u Glaims— lease com lete this section _ check box if this section does not a I
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
l�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 provided 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 � --ZZ—�-3 '
Print the Name of the Person who Completed this � � �r"e�`
Signature of Person Making the Claim:
Revised February 201 I
St. Paul Police Department#or
-� Ramsey District Court
RECEIPT
DatelTime: 02/11/2013 20:11 Invoice#: 18888
Vehicle Plate: 969ETM/MN �
Payor:°OWNER Location Paid: Impound Snow Lot
Amount:
Citation:
888749364 $ 53.00 ,
Total Amount Paid: $ 53.00
Paid by: CREDIT CARD
KEEP THIS COPY FOR YOUR RECORDS
_ ___ - --- - --�y----�. __- --� --_-----_.:..----�_��_
Saint Paul Police Impound Lot, 830 Barge Channel Road, Vehicle Release Form
Make: 88 FORD License#: 969ETM CIV:'13027844
Invoice#: 18888
ate/Time Released: 02/11/2013 20:11
Tow Charge: $ 123.95
Storage Charge: $ 0.00
R eased to:TOTO._
� Admin Charge: $ 80.00
Pa' by: CREDIT CARD
Tax: (7.625%)� $ 15.55
leased by:YOUA .
I,the undersigned,have recovered th�e anh�other problemsthat Subtotal: $
219.50
I will check the vehicle for damage Y 0.00
may have occurred while this vehicknowledge I w II reportf the Service Charge: $
Sain t P a u l P o l i c e D e p a r t m e n t. I a
damage and/or any other problemsound lom�und Lot staff To ta l C h a r g e s: $ 2 1 9.5 0
on this form prior to leaving the imp
Damage and/or other problem:
Police Repo�t made:Yes_No_IF Yes, CN
_, If NO,W.hy?
TO PROTECT YOUR RIGHTS REPORT ANY PROBLEMS/DAMAGE BEFORE LEAVING THE LOT
5/2000
Signature
. , . ; - . _
�_
, , . .,, ,; , . ,; . . , .
�.
. �: . �
. ' . , _. , `g:t ._ _ �
f X .4.
- � t
'. ' �' ,
I7eFa�ment ofPublic Works
� . Rich Aier,Director '
f ' _ ' �� . • .
CI� �F S�T PA� . Adminisfration Division
' Christopher B. Coleman,Mayor 1 S00 City�Yall Annez '
� ZS W,Fourth Street
' Saint Paul,�L1N 55102 :
� ` ' � 651-166-9800
� � . .
w
To: Vehicle Driver/Owner
From: Saint Paul Public Works �
Re: Parki.ng on City Streets during a Sriow Emergency '�.�
. . , . . . , . . J .
: You will find a snow emergency parking ticket attached to this memo. We issuecf this ticket because your car
was parked on a street that needed to be plowed. We want you to know that we did not want to ticket your car. _
All we wanted to do was clear the street of snow. Cars need to be moved to allow us to do the best job possible
for you,to make your winter travel in our City as safe and convenient as possible.
Even though you have already received this pazking ticket,you must immediately move your car to an appropriate
location to avoid being towed. . � , .
�, -
Information about how and where to pay your fine is included on.tl�e ticket. In the future,we wou'�d like to hel ou
P Y.
avoid this unnecessary expense and frustcation. We hope you fiud'the information below helpful. `�
. b
--- -- __u__
_�_
All snow emergencies start with Night Plow Routes at 9:00 P.M. on the day of the � �`
declared snow emergency. � - �� ;
Plowing begins on Night Plow Routes at 9:00 P.M. and continues through the nignt into
the morning until the snow is plowed to the curb. Parking is banned on these routes �;��1��� ������� Y`_ '
until snow is plowed all the way to the curb. This plowing operation takes 8 to�l2 �(�(��
hours to complete depending on the amount of snow. Night Plow Routes are typically ��{��� p�,�� , '
the busy streets--marked with signs that say 'TTIGHT r:;OW ROUTE" --plus,one side �L�� �Q uTE �
of north-south residential streets with signs that say "1VIGHT PLOW ROUT�=,T'HIS �'��g�a� ' ;
SIDE OF STREET." All downtown streets are on the night plow route. Look for these ���TE 0�BT�i��' j
- -
signs: f i
Day Plow Routes begin the following morning. There are nn signs on.L�ay Plow Routes. Plowing starts after the night !
routes are plowed,which is iypically around 8:00 A.M: �ng is banned on these routes until snow is plowed all the
way to the curb. The Day Plow Routes aze the east-west residential streets PLUS one side of north-south residential
streets--the side WITHOUT the plowing signs. There are some exceptions to these rules but they are all well marked.
The tagging and towing continues for 96 hours after the snow emergency has be�un. -' ''
There are some exceptions to these rules,but tl-�ey're all well mazked. Parking is banned until snow is plowed all the way
�
to the curb.
Snow Emergencies are publicized through major media outlets when dec�ared. You can sign up for our Snow Emergency
email notification list,learn more about snow emergencies in Saint Paul anu-see our rules in multiple languages at
www.stpaul.�ov/�ublicworks
Thank you for your help and cooperation.
'_Rev:10/ll
� rt•,;
2-22-13 , _
, .
As I understand the situation: .
I picked up my car from impound lot Monday(2/11/13)at the Como Fairgrounds location. .
I paid both citation and tow amount at that time.
� , .
Sunday(2/10) night I arrived at my home approximately between 10:00 pm and 10:30 pm from
a visit to my mothers in the Deephaven area,and parked out front of my home. The street
seemed passable with no discernable drifts.
I had heard no public service announcements on either 1500 KSTP AM or 1130 KFAN FM as I
d�ove home. I went to sleep approximately by 11:30pm with no street noise in front of my
home to react to at that time. I would think I could have reacted if plow lights were flashing or
the sound of a large vehicle was going down my street. I was informed the vehicle had been
towed between 12 midnight and 7:15 AM when I discovered it missing.
Upon arriving at work(Monday 2/11/13) I placed a call to Greg Tanem (Public Works) 266-9722.
He informed me that I was on the east side of Sheldon (even) and I was a night plow route
which woutd was to start at 9:00 pm . He also said to pick up my car at the Fairgrounds lot
where more than likely it had been towed.
Mr.Tanem had stated that an email was sent out from the city at 3 pm Sunday(2/10/13),that
starting at 9:00 pm night routes would be plowed�.I was not using a computer between 3:00 pm
and when f arrived home that evening and internal city emails are directed to my city computer,
end thus I would not have received notice at work on� Sunday. Mr.Tanem also informed me
that public service requests/announcements went out to media outlets, specifically I was to
have heard something on WCCO AM. `
I would appreciate any help you can give me in the relief of my tow and fine. I believe that
there was insufficient notice in the declaration of the snow emergency. I generally park on
Summit Avenue in the morning for work,which is a night plow route and assumed a side street
like Sheldon would not be consider a major arterial in the event of plowing.
; . _
I have lived in St. Paul a long time and obser.ve the snow emergencies if aware of them. Henry
Ung of Public Works is also aware of the situation and provided me with the claim document.
Thank you for your time in this matter. �
Paul Dubruiel � �
PED-City Planning •
266-6583
-