Hewitt RECEIVED
� MAY Og 2013
NOTICE OF CI.�� �Q R 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 be presented to the
governing body of the municipality within 180 days after the al[eged 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 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 ��I Za�j��\ [le t K Middle Initial�Last Name �"�
Company or Business Name
Are You an Insurance Company? Yes� If Yes,Claim Number?
Street Address �D (� �t �e �a V� �r� �^�.
City /"leU1��T� e l c���15 State M � Zip Code 7:J � ��
Daytime Phone(�e S I)ZRU- ��j$� Cell Phone�� - Evening Telephone(�S i) �tB�-�'�? "�1� �°
Date of Accident/Injury or Date Discovered o�- o � a o �3 Time � � ��� am�
Please state,in detail,what occurred(happened), and why you are submitting a claim. Please indicate why or how you
feel the City of Saint Paul or its employees are involved and/or responsible for your damages.
S� �e ����� �.� 3 v a a (r�(�-e r
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 W a'�c V t� �..a Cf vN p v�"�" _
Other type of injury—please specify
In order to process your claim you need to include copies of all auqlicable 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
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 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
Failure to complete and return both pages will result in delay in the handling of your claim.
All Claims—qlease 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 Unknown (circle)
If yes,what department or agency? Case#or report#
Where did the accident or injury take place? Provide street 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 l�n,��j�a.j-lc �r . 1V(;e vl o�n-�� �P i�l�t.�S� /U �U _S�/ 1�
Please indicate the amount you are seeking in compensation or what you would like the City to do to resolve this claim
to your satisfaction. �U•v0 �1"V 1c Lc�a f u`P�.Q o�"'1 1°Yl� C u-z'�
e: f . ;'D►it r vi c�p s
Vehicle Claims—please complete this section ,�check box if this section does not anvlv
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
Injurv Claims—please comqlete this section �"check box if this section does not anplv
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 f 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 �5�0� ���3
Print the Name of the Person who Completed this Form: L'l �Z q�'✓ 1 ��" �� ��
,
Signature of Person Making the Claim: �
Revised February 2011
May 6, 2013
St. Paul Regional Water Services
1900 Rice St
Saint Paul, MN 55113-6810
Dear Saint Paul Regional Water Services:
I'm writing to request that the$50.00 Service Fee be waived from my account. The reasons outlined
below.
1. I had difficulty finding a date to have new meter installed,one was finally scheduled for
12/14/2012. My son was home from college and my appointment for 12/14/2012
between 4pm and 6pm met our needs.
2. On 12/14/2012,voicemail message left on our home phone RE: appointment cancelled,
technician unable to make appointment.
3. I received no follow up calls or letters indicating water will be shut off on 01/31/2013.
4. I arrived home from work the evening of 01/31/2013 to find my water was shut off.
Hanging on my front door(I never use my front door)was the number to contact to
have water put back on.
5. On 02/01/2013 approximately 9am, I called the number provided on the door hanger to
resolve the water shut-off issue. Person fielding the call was very helpful and advised '
that someone could meet me at my house within the hour to change out the meter. I !
was calling from work, so I droue home and meet the technician within the% hour. '
7. On 02/01/2013 (approximatel�9:20) met the technician at my house and he quickly '
replaced the old meter with the new meter. The technician was very courteous and did
a nice job. He told me I would have to call to have the water turned back on. I
explained I needed to go back to work and he advised that I could call later. Since I
would not be home from worl�until after 6pm, I asked if calling after 6pm was too late,
he said that was not a problerni.
8. On 02/01/2013 at approximat�ly 7:OOpm, I called to have my water turned on.
Technician arrived soon after call. It was snowing and cold and he was having difficulty
finding the valve in the ground. Many, many attempts were made. He worked both
outside and inside at the site of the meter in my basement. This went on for at least an
hour. He asked if I had a hair dryer and a coat hanger, which I provided. Still no water
and I was losing confidence in his judgment. As his truck was running just outside my
garage, my basement was full of exhaust fumes and I retreated to my main level for
Page 1 of 3
fresh air. I went back down to the basement and found he had removed the new meter
and was attempting to open the water line outside. I was puzzled, I'm a nurse, not a
plumber I thought, but I said "when the water goes on won't the water come gushing
into my basement?" He replied, "Yes,that's why you're here,you can run and turn off
the valve." Off he went outside, and sure enough the water came gushing, I ran to turn
off the valve, but was unable to turn the valve, at this point I yelled outside that the
water is on! He then, shut the value off outside. I was drenched,the water meter room
was flooded and I thought I was on an episode of Candid Camera! He grabbed some
towels off his truck and mopped up the mess. I ran to get more towels to wipe down
the woodwork and wood bookcases. I had a small 3'x 5' area rug that was completely
soaked,that was placed in the garage to dry(really freeze and then dry). The technician
re-connected the new meter,turned on the water and quickly left no apology. Feeling
completely helpless, I thought I better snap some pictures because this is truly
unbelievable.
9. Currently,the brick exterior wall is covered with dirt from the attempts at turning off/on
the water on 01/31/2013 and 02/01/2013.
You may ask, why did you wait this long to file the complaint? First, I was upset; I wanted time
to cool down. Second, I was out of town for most of February and March. Lastly, I knew the
$50.00 service change was going to be applied to the next bill and figured I would wait until then
to notify St. Paul Water of my issue,since it was not an emergency.
Thank you, �
���L� ' I
� i
Beth Hewitt I
619 Maple Park Drive � I
Mendota Heights, MN 55118
Daytime phone 651-290-8584
Evening phone 651-4552716
�
Page 2 of 3
Pictures taken on 02/01/2013 RE:water in basement and on walls and furniture.
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Page 3 of 3
' ' Saint Paul Regional Water Services Retain this po�tion of the bill for your records
� 1900 Rtce St. 5%Late Charge will be added 30 days
--.......
Saint Paul, MN 55113-6810 after the billing date.
Senrice Address: 619 MAPLE PARK DR
Account Number: 0613795
Customer Number: 042929 BILLING INFORMATION
Billing Date: 04/04/2013
Due Date: 04/19/2013 Previous Balance $36.39
Payments $36.39CI
ELIZABETH HEWITT BALANCE FORWARDED �0.00
619 MAPLE PARK DR
MENDOTA HEIGHTS MN 55118-1840 CURRENT CHARGES
i�PII�iIIhIPi���iy���u�i�i,n���uh�h�i.in�i���uul�rll
Water Service Base Fee $10.80
Water Usage Charge $19.25
Water-Surcharge $3.01
MISCELLANEOUS CHARGES
Service Charge $50.0
METER READINGS TOTAL CURRENT CHARGES $83.06
Current Current Previous Previous Usage Days TOTAL AMOUNT DUE $83.06
Date Reading Date Reading
2/1/13 863 12/28/12 858 5 35
3/27/13 2 2/1N3 0 2 54
Total 7 89
Prior Period 6 93
Last Year 14 92
SPRWS meets all standards for drinking water quality. To read *he full water quality report, go to www.stpaul.govlwaterquality.
Paper copies are available upon request 651-266-6350.
SPRWS satisface todos los estandares de calidad de agua potable. Por favor dirijase a www.stpaul.gov/waterquality para leer el reporte
completo de calidad del agua. Copias en papel del reporte solamente est�n disponibles Ilamando al 651-266-6350.
SPRWS waxay la kulantaa dhamaan heerarka u dagsan tayada biyaha la cabo. Si aad u akhrisid dhamaan warbixinta ku saabsan tayada
biyaha,tag www.stpaul.govMraterquality. Waxaa la heli karaa kqobiyada warqadaha marka laga codsado tel.651-266-6350.
SPRWS ua tau zoo raws li tag nrho cov quag ntawm dej zoo h�us. Xav nyeem tsab ntawvi ceeb toom tag nrho txog dej zoo haus, mus rau
www.stpaul.gov/waterquality.Tsuas muaj cov ntawv luam tawm yog nug txog ntawm 651-266-6350.
Moving?Please call Customer Senrice at 651-266-6350;TDD hearing impaired at 651-266-6288 �
E-mail us at waterinpuiries(c�stpaul.qov To pay your bill online go to billpav.saintpaulwater.com
---°-----------------------------------------------------------------------------------------------------------�--
Detach here and mail bottom portion with your payment.
Saint Paul Regional Water Services
1900 Rice St.
Account Number: 0613795 Saint Paul, MN 55113-6810
Customer Number: 042929 Make Checks Payable to'SPRWS'
Route Number: 305-120
Service Address Due Date April 19,2013
619 MAPLE PARK DR
MENDOTA HEIGHTS � $$3.06 �
Please Pay This Amount
ELIZABETH HEWITT
619 MAPLE PARK DR
MENDOTA HEIGHTS MN 55118-1840 � �� O �
Enter Amount Enclosed
042929061379500000083063