Enterprise (3) 1 �f�
Enteiprise Rent-A-Car
PO BOX 8�2��2
DALLAS.TX 752842�42
Th�irsday.Aprii 18, 2013
(���`.�'�1.���.. �
CIT'�'CLERK OF ST PAI��L �� "`
310 C:ity Hatl APR 2� 2Q�3
15 Kellogg Blvd.,West
ST.PAI:L,��m sg�o2 CITY CLEF�K
Rp: ci�t►��o. o�3os 3s.r _ -
Date ofLoss 11/0"2012
Balnr�cp Due .�386.68
Dear Sir,'Madam:
As of the above date,we have not received a response from you regarding ot�r elaun as doc�unented
in aur previrnis carrespondeuce
If you have reported a clairn to your uisurance coinpai�y,please covtact us itnmediately with your
pertuient claim i�ifoimation, If yau do not have iusurance or wish to pay this claun yaurself,you will
�ieed to remii payment to tl�e atwve address within ten(10)days of the above date. Please i�iclude our
ciaim number on your payment_If you prefer you may aiso pay usi��a debit card,credit card or =
directly from your bank accotu�t at the followu�g website: _
https:flwww.vel�citypa}nrient.cou�IclientJUankafacx�erica/erac/index.htm
If you ha�e auy questions regardin�your responsibiliry for tlus loss,please contact our office.
Faiiure to respond cauld result in ad�litionaI collecrion activity.Yo��r prompt attention ta this matter is
appreciated
Sincerely,
LTC LTC RECOVERY 7L02
Recovery Specialist
dru2(c7iehi.com
Damage Recovery Unit
DIRECT: 866-300-3?38
OFFICE: 866-�00-3238
F.A3i: 888-8?4-8937
2 of 5
I?�'VOICE
Date: 04/18/2013
CITY CLERK OF ST PAUL Claim#: 03308344
310 City Hall Unit#: 7GFLGQ
15 Kellogg Blvd.,West Billiug Invaice#1: 6122b308
ST. PALTL,MN 55102
Velucie Infonnatiou
VIN: JN8AE2KPSC9039621
Year: 201?
Make: NISN
Madel: QLTES --
Item Total C:ost Amouut Due
Da�nages $28Q.70 $280.?0
.�dmiuistrative Fees $50.00 �50.00
Loss ofUse $55,9g $55.98
1.400 days 4�539-99?day;a IDO°a acupancy
Dimuiislunent of Value $28.07 Waived
'Total Amounf Due: $386.68*
*Remit payment in U.S.Dollars.
PAY L�UN RECEIPT =
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
ALL PAY141E�TS 1�1UST INCLL;DE THIS RE?��1ITT'ANCE TO BE CREDI?ED PROPERLY!
PAYABLE TO:
DAMAGE RECOVERY UNIT Claii�l#: 0�308354
PO BO�8�2442 Uuit n: 7GFLGQ
DALLAS.TX 752842442 Billing Invoice#: 612253Q8
Toll Free#: 866-300-3238
Total Amount Dne: S 386.68*
*Remit payment ui U.S. Dollars.
Total Amonnt Remitted: S
3�f 5
Ot�r claim munber: 03308354
Your Claim Information
Yaur insivance i credit card compavy:
Your claim nun�her:
Name of claims adjuster.
Adjuster 1 company email address:
Adjuster/company phone number:
Adjuster/coinpauy fax number:
Adjuster!coiupany mailing address:
.4ddress
City, Stnte, Zip
Please repl�r to:
Damage Recovery Unit
Einail:DRU2Cehi.com or
Fax: 888-874-8937
Phone: 866-300-32�8
Mail: PO BOX 842442 DALLAS.TX?52842442
4of5
NOT'ICE OF CL�IM FORM to the City of Saint Pau1, Minnesota
�lirenerorrr Stnte Statutc AGG.OS sinres that"...evcn�/�ersat...�r•ho ctainu clar+wges jrorrr ar:y nir�akiputilti...s/ral!canse tn be preserue�!�o rl�e
gorerniag bady qT dte rn+micipaliry rritlria 180 days crfur tke afleged loss or-inj�rry is ali.ccovere�l a notiee sratu:g rhe+rruc,place,mid
r.lrcmnstances Nierenf,arzd tlte ari�nuru n(c4�npe�tsaUrnr or ndeer�rfirJdenta+eds-tl."
Please complete this form in its entirety by clearly iyping or printing your nnswer to ench qnestion. If more space is
necdcd,attech additionai sheets. Ylcase note that pou will not be contacted by telephone to darify unswers,so provide as
much information as necessary t�explain your clairn,anr!the amount nf cocnpeasation being requested. You wiil receive a
tivrilien acknowIedgement once y�►ur form is received. 9'he proces.5 rnn take up to ten w�ceks or toager dependiog on tl�c
�ture of your claim. This t'orm must be signecl,and 6oth�►ages coinpleted. lf something does not apply,write`N/�1'.
S�ND COMPLETED FORM AND OTHER DOCUMENTS T4: CITY CLERK,
15 �'VEST KELLOGG BLVD,310 CITY HALL,SAINT PAUL,IVIN 55102
I'irst Name Mi ddle Initial_.__._.,Las[Name
Company or Busi�iess Name�T��lZ1 t� �1�T- �-- C��- u__ - - - --
Are Y u�urance omp�any? Yes/ho If Yes.Clairn Number? 0�2.C.���S�-{ __r..�__...
Street Address �7 !� �., ���-��2-
City l..a�'"l �� State �X "Lip Code�"____,�_'�J ZS��-�
Dayiime Phc�ne�yy,�.�..�-u'3�e11 Pho�e(__,..).,,Y Evening TeEepl�one{ ) -
Date of Accident/Ittjury or Date niscovered-��-�--•i-�.,���_`fime��am/ m
Please state,in detail,what occurred(happened),aod why you are sobmitting a claim.Please indicate why or how you
feel the City of Saint Paul or its emgioyees are involved and/or responsible 1'or your da�nages.
�1"—�����C.LLC.2_._.�.-�� V S -`�-
1' � ✓1 - n�� e=.-�
r� �- �t �� ' _
p '�YL�._..G �1Y��. �--r� -�-h�P_ _ =
' V �.� — =
Plea3e cEieck tf�e box{es}[hat most closely repzesenl the reason for completina this form:
�'M}veivcie was damaged i�i an accident 0 My vehicle was damaeed during n tow
� My vehicle was dama�ed hy a pothole or condition of the street D bsy vehicle was daEnagecl by a plow
� My vehicle was wrongfully towe�l and/or ticketed O 1 was injured on City praperty
�Other type of prope�ty dama�e-please specify _._.�—
L�Ucher type of injury-pleas�e speciiy
In order to process your claim you nced tu include capies of all aanlicable ducumenis.
For the claims���pes listed below,please be sure to include the documents indicated or it will delay the handlin�of
vour claim. Documents WILL ilOT be retu►ned and become the property ol"the City. You are encouraged to keep a
copy for yourself before submitting your claim form.
O Property damage cluims to a vehicle:lwo estimates for tl�e repairs to your vehicle if the d�mage exceeds
�500.00;ar the aclual bills andlor receipts for the repairs
O Towing claims:leaible copies of an}�tickeE issued and a co[�y of the impound tot receipt
O Otlier property darnage claims:two repair estimates if the damage exceecis$�00.0(1;or die actual bil)s
and/or receipts for the repairs;detailed iist of damaged items
O Injury claims:medicnl bills,reeeipts
C{�Photogr�phs�re�lwuys�ve3come to docurr�ent and support your claim Uut will not be retumed.
Page 1 of 2-1'lease complete and retarn both pa�es of Cis�im f+orm
�of 5
Failure to complete and return both pages will result in del�y in the handlin�nf your ciaim.
Ali Clairns-please compiete this section
Wcr there witnesses t�the incident? � No Unknown (circle)
Provide their numes,acldresses and telephane numbers:�'[Z��.t�C_�Q.�}P.)—S� '�v�tpt�.2»'S
�n�l - ���=,-C�v�,�
Were the police or l�w enforcement callcd? e� No Unknown (circle)
If yes,w6at clepattntent or agency'? �iPPI� Case#ar report# l 2���.S�t
U�t� -�`1�- ��C'�-1�-'211�}�A-�/C.�K-.
Where did the accident or injury eake place? Provide streec adciress,cross str�et,incersectinn,name of park or facility,
closest Ilndmark,ece. Please be s detailed as possible. If necessary,attach a fliagram.
ii 1 t)v��ye�r5►k-t.,c �f-? t�• �T p�tu,L p��.} Ss�p��
I'lease inc�icate ihe amo nt vou are seeking in compensatinn or what you would Tike the CiCy to do to resalve this claim
�to your satisfaction. �'��(.o� (o��
Vehicle Claims- lease com lete this section O check iwx if this sec;ci€�n does not a 1
Your Vehicle: Xear 01 Make lSS IVtoc�el�,,, FS
License PIaEe I�tumber �: State I t� Color
ReGis[ered Ow�ie�• Q 1 � �- IT�W S
Driver of Vehicle -
Area DArnaged
City Vekiicle: Year#)�!L-'-- Make iti4c�dei „
License Platc Numt�er � State t��Colar N
Dri�er of Vehicle(City Employee's N�me) l�y�}[�C,�wY�.._� ~"%_('�.X� ._�_
Are�Damaged �f�s'
Injur�Cfaims nlease comnlete this section , check box if this section does not annlv
How were you injured? -
Vt'hat parc{s}of your body were injured?.___..-------._.�_..._.__.___._.�_.......___.___.___._.._.._____....�._.___��._._—__._..__..... _
Have you sought medica]treatrnent? vY�.s No Planning lu Seek Treatrnent(circle) ��� _
When did you reccive treatment? (provide date(s)) —
Name of Medical Provide�•(s):
Address 1'elephone
Did you miss work as a result of your injuiy? Yes No
When did you miss work? (provicle date(s})
Name of vour Employer:
Address Telephone
'�,Check here it yau aee attaching more pages ta this claim form. Number oC addiiional pages�.
By si�nirag this fvrna,you are stating that all iraformation you have provided is tnce and correct tn the besr
o f yvur knnwledge. Unsigned fo�r�ts will not be processed.
Subrnilting a false clui�n ca�i result in nrusecutian. Date form was comkleied ,`�I�.L�2.C7!�.
�'rint the Natne of the Person wha Cnmpleted js Form:��-�Q�._L",��'�
t
Signature of I'erson i�Iaking the Claim:_.�
Revised Fcbniary 2U1 t