Whitney ��cE�v�o
' MAR 2 9 2013
NOTICE OF CLAIM FORM to th���ity�����rit Paul, Minnesota
Minnesuta State StaCUte 466.05 states that°...every�erson...wlw claims damages from any municipality...shall cause to be presentecl to die
governing bocly of tdae m�unicipaliry within 180 days after the allegecl loss or i�ijitiry is cliscovered a notice stating the time,place,and
� circumstances thereof,anci the anwunt of compene�ution or other relief demaruied."
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 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�a��-E Middle Initial� Last Name W � �rN �
Company or Business Name N�A
Are You an Insurance Company? Yes/�To If Yes,Claim Number? �/�
Street Address��"T l.�[��U►�Eri �y�
City S� Q��/'��— State /v 1�'v Zip Code J� � �
Daytime Phone(b����-�'-y�� Cell Phone( '—j—"- Evening Telephone(�s�)2�1- I�
Tim�W am��m
Date of Accident/Injury or Date Discovered �G'� � � �-0�2- �ktLt p
Please state,in detail, what occurred(happened),and why you are submitting a claim. Please indicate wh or how you
feel the City of Saint Paul or its employees are involved andlor resPonsible for your damages.T WaY1.� tv be �d
cost k� re au r a [ e e.v�ack aN �n�2�aK ��FsTER w�1 t F �NrNb- Qp m �t
E C� � s�. N 7 C h seve�e v�gr�.tr ,�u0
�- rN �tuvSE � Es�� o £ �� cva rNtv�ni[. D thtr�ti
d � � l t f�fL D N ( Z
r�' :ov �nrn �,�o � ..—�EC,2p-4� r s �rEw a-lud ED
k�N . Ut�t� A�12 1�19 U. L FF! /F i�1
So � ti� W-y�v .
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
❑ My vehicle was damaged 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 injured on City property
�Other type of property damage—please specify�A{.� Tb �Y(,'��j2-lU�f LA'S'(�W� [N �lN/I11�3' �.�m
❑ Other type of injury—please specify
In order to process your claim you need to include copies of all applicable 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 WILL NOT be returned and become the property of the City. You are 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 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 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 far the repairs; detailed list of damaged items
O Injury claims: medical bills,receipts
• 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
. P� 2
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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:d�L,�W�'!�1'J� D�1� �Tt�� ��OYVIU t�,
�f2���12.o�kVE,srP���Ni�1.55io�, �St 22zus�i
Were the police or law enforcement called? Yes No Unknown (circle)
If yes, what department or agency? ��� Case#or report# N/fs.
Where did the accident or injury take place? Provide streelt address,cross street, intersection, name of park or facility,
closest landmark; etc. Please be as detailed as possible. If necessary, attach a diagram. �l(�l(VC� t'Z00�)
��?,�} CN�(taKt"E AcV��St Qf�U(.� MN �S�o1
Please indicate the amount ou are seekin,g in compensation or what ou would like the City to do to resolve this claim
to your satisfaction.���'��IM�UrSCrYIfJ�'[' ��3�6'� �[T� �',ST�rL(ZEI�l�-�R 1�kND (Z�"P�INT/N6'
wC�,4l� �v�n�nr��vG P� fin E+o►NtEUwnt-�2
Vehicle Claims—please complete this section �check box if this section does not applv
Your Vehicle: Year Make Model �
License Plate Number State Color
Registered Owner
Driver of Vehicle
Area Damaged
City Vehicle: Year Make Model
License Plate Number State Color
Driver of Vehicle (City Employee's Name)
Area Damaged
Iniurv 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 medical treatment? Y s o 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
�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 ��I?`g/ �(3
Print the Name of the Person who Completed this Form:��C 1�. �,w�'f'�����
Signature of Person Making the Claim: V�'� " W`" �� ,
Revised February 2011
University of Minnesota Mail-Cherokee Regional Trail Update https://mail.google.com/mail/u/0/?ui=2&ik=46f79ed46e&view=pt...
. w��r�-�y ���
Gayle Whitney <gwhitney@umn.edu>
�
Cherokee Regional Trail Update
Messer,Alice(CI-StPaul)<alice.messer@ci.stpaul.mn.us> Mon, Oct 1, 2012 at 1:18 PM
Cc: "Kunerth,Vicki M (DHS)"<vicki.kunerth@state.mn.us>,"gwhitney@umn.edu"<gwhitney@umn.edu>,
"gayleandsteven@comcast.neY'<gayleandsteven@comcast.net>, "Dittrich, Mark(MDA)"<mark.dittrich@state.mn.us>,
"mdittichjewelry@visi.com"<mdittichjewelry@visi.com>, "pkrull@comcast.neY'<pkrull@comcast.net>, "j.boy@comcast.net"
<j.boy@comcast.net>,"ggray080476@comcast.neY'<ggray080476@comcast.net>, "Icasserly@yahoo.com"
<Icasserly@yahoo.com>, "J.swiler@comcast.net"<J.swiler@comcast.net>, "Karen.Thompson@securian.com"
<Karen.Thompson@securian.com>, "hok10002@umn.edu"<hok10002@umn.edu>, "barone.m@comcast.neY'
<barone.m@comcast.net>, "heidi.hough@target.com"<heidi.hough@target.com>, "caseyselix@msn.com"
<caseyselix@msn.com>, "Danlifjedahl@gmail.com"<Danliljedahl@gmail.com>, "stubieads@comcast.neY'
<stubieads@comcast.net>, "gusa1 brad2@aol.com"<gusa1 brad2@aol.com>,"andrewjpaulsen@gmail.com"
<andrewjpaulsen@gmail.com>, "kjwojtan@gmail.com"<kjwojtan@gmail.com>, "treesaw43@comcast.net"
<treesaw43@comcast.net>, "dennybray43@yahoo.com" <dennybray43@yahoo.com>, "krumly@comcast.neY'
<krumly@comcast.net>, "cjharding1@comcast.neY'<cjharding1@comcast.net>, "kjoyleo@gmail.com"
<kjoyleo@gmail.com>, "kate.vickery@mac.com"<kate.vickery@mac.com>, "randiwalz@hotmail.com"
<randiwalz@hotmail.com>, "walzbj@gmail.com" <walzbj@gmail.com>, "jill.azocar@gmail.com" <jill.azocar@gmail.com>,
"dbrownhd@gmail.com" <dbrownhd@gmail.com>, "daniel.vickery@mac.com" <daniel.vickery@mac.com>,
"holm.david@gmail.com"<holm.david@gmail.com>, "jconrod@alumni.macalester.edu" <jconrod@alumni.macalester.edu>,
"swovcha@yahoo.com"<swovcha@yahoo.com>, "klejennifer@gmail.com" <klejennifer@gmail.com>, Jim Ingmenson
<jimonpark@hotmail.com>, "PAMSTEVEKELSEA@email.msn.com" <PAMSTEVEKELSEA@email.msn.com>, Susan
Barker<susankwb@aol.com>, "Lise.schmidt@comcast.neY'<Lise.schmidt@comcast.net>, "Palmer, Ginger(CI-StPaul)"
<ginger.palmer@ci.stpaul.mn.us>, "Mark J. Daubenberger(mark.daubenberger@tkda.com)"
<mark.daubenberger@tkda.com>, "Ganje, Don (CI-StPaul)" <don.ganje@ci.stpaul.mn.us>
All -
In response to concerns from residents in regards to vibration levels being felt from sheet pile driving; I
have stopped driving of sheet pile for today so we can install seismic monitors to monitor vibration levels.
Tomorrow morning,Tuesdav October 2nd at 7:30 am we will have the geotechnical engineers onsite to
explain the process and answer any questions you might have in regards to vibration levels and trail
construction. We will be meeting approximately in front of 456 Cherokee Avenue.
Please attend if you have any questions.
Thank you,
Alice
1 of 1 10/1/2012 4:45 PM
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RE: Claim Form Process
From :Ginger Palmer(CI-StPaul) <ginger.palmer@cistpa I.mn.us> Tue, Oct 02, 2012 07;18 PM
Subjed: RE: Claim Form Process
To:Alice Messer(CI-StPaul) <alice.messer@ci.stpaul, n.us>,
gayleandsteven @comcast.net
Cc:Sandra Bodensteiner(CI-StPaul) <sandra.bodensteiner@ci.stpaul.mn.us>
Hello, Gayle-this will confirm our telephone conversation of this morning about damages to your home as a result of work
being done on the Cherokee Regional Trail and the City's responsibility for them.
It is my understanding from this morning's discussions that, in response to the concerns you and your husband voiced
yesterday about the impact from vibrations during construction of the trail, construction was shut down yesterday. The
specific concerns you've mentioned so far are a crack in the wall(not sure of location), possible washing machine damage
(leaking at the same time as the vibrations were being felt)and vibrations strong enough to cause china to shake and move.
Alice Messer had representatives of Braun and the contractor on site this morning to discuss the geological issues with the
metal sheets being installed for trail stability. The installation into the bedrock is causing vibrations which you could feel
yesterday, and which caused the issues above. We discussed the fact that they would install vibration monitors outside and
inside of your home to monitor the vibration levels going forward. There are acceptable vibration limits set for different
types of construction and the contractors will monitor vibration levels acceptable for plaster residential construction. If the
vibration limits exceed the range for plaster residential construction I understand that there will have to be another
discussion on next steps for the project. If the levels stay within the limits, the expectation is that construction would
continue. There will also be monitoring of the wall crack that developed in your house yesterday.
Below Alice has given the link for information on the process for making claims against the City. I informed you on the
phone that it was my expectation that you would be submitting a claim for damages to your home as a result of the
construction activity and that the City would potentially be responsible for some of the damage. I told you that I could not
guarantee that there would be payment for any/all damage because a lot wouid depend upon what you were asking for and
whether it was caused in part or in whole by the project. I should add that there are some statutory protections for the
City against payment of damages, which may or may not apply in this instance. I know that this is not the full assurance
you want that you will be reimbursed for all damages caused, but the primary purpose of this message is to let you know
that I am aware that you have had some damage to date and that there is a process for resolving the city's responsibility.
After this morning's meeting, Parks has determined that it is best to proceed with construction and it is anticipated that
another 2-3 days remains of the metal sheet driving. The City wants to be sensitive to the needs and concerns of the
residents, while still ensuring that the project can proceed as expeditiously as possible so that we do not end up with weather
delays. Please let me know if any further problems arise.
Virginia Palmer
Assistant City Attorney
400 City Hall
15 W. Kellogg Boulevard
St. Paul, MN 55102
(651) 266-8710
From: Messer,Alice(CI-StPaul)
Sent:Tuesday,October 02, 2012 11:59 AM
To: gayleandsteven@comcast.net .
Cc: Palmer,Ginger(CI-StPaul)
Subject:Claim Form Process
Gayle-
1 of 2 i 12/]8/2012 3:49 PM
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As requested,attached is the link to file a Claim against the City. Please contact Ginger Palmer if you have an questions at 266-8710.
http•//www stpaul gov/index aspx�NID=186
Thank you,
Alice
Alice Messer
Landscape Architect
Department of Parks and Recreation
25 West 4th Street,Suite 400
Saint Paul,MN 55015
651.266.6412(direct)
.� _ .
2 of? 12/18/2012 3:49 PM
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PLUMBLINE C UMPANIE S• INC.
Minnesota State Contractor License Number BC497386 l
� 1847 Montreal Ave,5t.Paul,MN 55116 � Phone/Fax: 651.646.1309 �
3J27/2013
Gayle Whitney
434 Cherokee Ave.
St. Paul, MN
Re: 15L Floor Living Room Wall Repair and Painting
Remove loose plaster as needed/requested at large crack in west wall. ReplaceJrepair
lost plaster with drywall techniques(Durabond Compound)and fiberglass mesh reinforcing
tape. Owner to make minor wall repairs for the balance of the room.
Prime raw surfaces and paint the room with 2 coats of quality eggshell acrylic paint(Benjamin
Moore or Sherwin Williams). Wall surface approximately 300 sq ft.
Price includes dust control and final dust free cleanup,all debris properly disposed of.
Materials: $105.00
Labor: $275.00
Total Cost to provide materials and labor as described: $380.00
William J.Cumming
L.��_ ` ��
Pres/owner
Plumbline Companies,Inc.
, �
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COMMERCIAL AND RESIDENTIAL CONSTRUCTION SERVICES NAT-104223-1
. � I� ��.��,� ����,i��
LaDuke's Renewsit
3404 Dale Street N
Shoreview, MN 55125 Date siz8/zoiz
Invoice Estimate
�`_
651-483-9791
Gayle and Steven Whitney-Komula
434 Cherokee Ave
St. Paul, MN 55107
DESCRIPTION AMOUNT
Tape and plaster cracks in dining room, sand prime and paint �J
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Labor @ $40.00Jhr ��ZV•
Materials
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Total estimate �
TOTA *
Please make ali checks payable to Curtis LaDuke.
Feei free to contact me if you ha�e any questions regarding these charges.
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