Smaller ��c�ivE�
J U N 17 2013
NOTICE OF CLAIM FORM to th�,� �� Paul, Minnesota
Minnesota State Statute 466.05 states that "...every person...who claims damages from any municipality...shall cause to be presented to the
governing body of the municipality within 180 days after the alleged loss or injury is discovered¢notice stating the time,place,and
circumsfances 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 ezplain 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� ,��_ Middle Initial�_Last Name�� �,(��,61
Company or Business Name ����
Are You an Insurance Company? Yes� If Yes, Claim Number?
Street Address������Q.�' �/� ,�/��
City ; �'�''. /Ja w G State 7'�21U - Zip Code 5`�� /��/
Daytime Phone (�j�2�;�- S'Xo 8 Cell Phone��� � � Evening Telephone L� _�_ J +
Date of Accident/Injury or Date Discovered� /%�� ��,� Time o � am pm
Please state,in deta.il,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.�.,,v ,�/3�/eo2 G' Q��,
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Please check the box(es)that most closely represent the reason for completing this form:
0 My vehicle was damaged in an accident � My vehicle was damaged during a tow
❑ My vehicle was damaged by a pothole or condition o£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,n ° ,1`�,�Z'�z; eL'f{�%v � OuDt?_ t?'_S'�o)6�2c��o�
❑ Other type of injury—please specify
In order to process your claim you need to include couies 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 WII.,L 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—please complete this section
Were there witnesses to the incident? � No Unlrnown (circle)
Provide their names,addresses and telephone numbers: �j t`"�t�u �� •�t,��'GL ,5��t������
� ' czGl %�'S'`�" F�2
Were the police or law enforcement called? Yes No Unlrnown (circle)
If yes,what department or agency? ��d2Z,���- c Case#or report# /�7 ��;Z o� °5 I G,
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. �i> ��/ � ��
�.�o m d-�S'J'�a/�l �U� m�G�`��, rna,�P S�� S'9� �'�cc.0
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. '�� . �5�� � /��i . � l�°� R-���F v D 'C'
Vehicle Claims—please com�lete this section D/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
Injurv 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? Yes No Planning to Seek Treatment(circle)
When did you receive treatrnent? (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 processec�
Submitting a false claim can result in prosecution. Date form was completed
Print the Name of the Person who Completed this Form: �l�' ��� c��,� lf�c,�
Signature of Person Making the Claim: �;�� ,c�����, -j
�^
Revised February 2011
warranc �-�
SEARCH WARRANT .
STATE OF MINNESOTA,COUNTY OF RAMSEY DISTRICT COURT
'f0: PAUL TORGUSON,(A)PEACE OFFICER(S)OF THE STATE OF MINNESOTA.
WHEREAS, PAUL TORGUSON has this day on oath,made application to the said Court applying for issuance
of a search warrant to search the following described Premises, :
Remaining 34 missing handguns from Gander Mountain burglary on 07/13/2012
[31ack Rocowear s�veat shirt
Computers,Ccil phones,digital cameras,datti storage devices such as USB devices
Re�ident Dacument
l,ocated in the City of Saint Paul,County of Ramsey, �nd STATE OF MINNESOTA for the following described
property and things:
Single family dwelling located at:
930 Marshall Ave
Saint Paul,MN 55104
WHEREAS,the application and supporting affidavit of Paul Torguson was/were duly presented and read by the
�oart, and tieing fully�ulvised in the premises.
NOW,THEREFORE,the Court tinds that probaoie cau�e exists ior tT�e issuanc�ef a search�.-:.:rrant upon the
following grounds:
- T8e property above-described was stolen or embezzled.
- The property above-described was used as means of committing a crime.
- The possession of the property above-described constitutes a crime.
- The property above-described constitutes evidence�hich tends to show a crime has been committed,or
tends to show that a partieular person has commit d a crime.
"I'he Court further tinds that probable cause exists to believe that the above-described property and things will be
at the above-described premises, .
�'he Court further finds that the entry without announcement of authority or purpose is necessary to prevent the
loss,destruction,or removal of the objects of said search and to protect the safety of the peace officers.
NOW,THEREFORE,YOU THE PEACE OFF:C�'!t(S)AFORESAID,AND ALL OTHER PERSONNEL
UNDER YOUR DIRECTION AND CONTROL ARE HEREBY COMMANDED TO ENTER WITHOUT
��NNOUNCEMENT OF AUTHORI'CY AND PURPOSE BETWEEN THE HOURS CiF 7:00 A.M.AND 8:00 P.M.
OR A NIGHTTIME SEARCH OUTSIDE TI�OSE HOURS TO SEARCH THE DESCRIBED PREMISES, FOR
fHE ABOVE-DESCRIE3ED PROPERTY AND THINGS,AND"I'O SEIZE SAID PROPERTY ANU THINGS
.WD TO RETAIN TfIEM IN CUSTODY SUBJECT TO COURT ORDER AND ACCORDING TO LAW.
I3Y TFIE COURT:
✓'l
Dated: �=� �_� ���� �.n�`� t/� 1 C,`��.Q_/��---
�- JUDGE OF DISTRICT COURT
. '� - O O �----
t't�PIES"[�O: COURT • PROS.A"TTY • PF.ACE OFFICF.R • I'REh11SES/PERSON
BOOKER CONSTRUCTION INC.
336 West Water St.
ST. PAUL MN. 55107
(651) 644-1026
FAX (651) 644-3646 O1/24/13
PROPOSAL & ACCEPTANCE
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
Richard Smaller Same .
930 Marshall Ave
St. Paul, MN 55104
952-�51-8808
Remove and replace front entry doors, exterior and inside vestibule, complete with jamb, trim, threshold handsets
and deadbolts.
Stain and varnish to match existing as close as practical.
Note: Trim will be reused where possible.
$3,850.00
REMOVE ALL DEBRIS C 'EATED BY WORK TO BE DONE
PROPOSAL INCLUDES: ACCEPTANCE OF PROPOSAL:
��LL LA[30R AND MATERIALS AS REQUIRED[N TI IG A[30VE PRICE,SPECIFICATIONS ANU CONDITIONS
�CCORDANCE WITF{THE ABOVE SPECIFICA"I'IONS ARE ACCEPTED.YOU ARE AUTI IORIZED TO COMPLETE
TEIIS CON'I'RACT AS SPECIFIED.PAYMENT WILL BE MADE
�1S OUTLINF,D'TO THE LEFT FOR THE AQOVE MENTIONEU PRICG
PAYMENT TO BE MADE AS FOLLOWS:
DOWN PAYMENT OF 50% OF PROPOSAL
I�UE AT START OF CONSTRUCTION.
BALANCE DUE UPON COMPLETION.
�\U�HORI'l_ED SIGNATURE
�U"Il IORI"LEU SIGNAI'URE �n�re or•ACCEPTANCE
Emmett Booker, Booker Construction Inc.
�LL M1IATERIAL IS GI;ARAN'IEED TO 0E A�SPECIFIED.ALL WONK TO BE Cn1�1PLETED I�l A WOHF:MANLIKE�IANNER AS PF:H STANDAItD PRACTICF..A�Y AI:iE:RATION FROM THE AHOVE$PECIFICATIOhS INVOLVING L:Y'!RA COiT
�ILL aE f)ONE ONLY I:PON WRITiEN pRDi;RS.tOR�ID Pl.'RPOSES AI.L SIUEWALKS TO HE RE"MOV[D.IS BELIEVED TO�E J'IN'I711CKNESS AND COYI'AINS NO NEIVFORCING BAR OR WIRE MESH.IF THI(�K4E55 t�CF.f:DS J"OR
'.+��.�tiF'(iNCI�C IS FO�ND.i71E OWNER WILL UE NOTIFI[D A4D PRESENTED`.�ITH AD�IIIOh'Af,C()STC FOR APPROVAL.OWNER TO CARRY FIRE,TORNADO AND OTHER`IECESSARY INSURANCE.OI:R WOR/:GRS ARL FUI.Ly('()VERED
-3'i�l'�){:I:�fAUS�'()�1FE�CATION IN.ti�RANCE AS R[(�UIRED 9V T}Il�:Sl'AR;OF I�IIh`�ESOTA.
'�l iF:�f II15 YRf)PO�AL�NAV DP.W I"ffIDRAW N BY l:J IF NU'1'ACCi;P"1'f:D W 1'1'f11N JII DAYS.
Jl)lllCERC'()N5TNI:CTIONI1f.W()li1,Dl.IKF.TO'1'HANKYOIiF(1RTIIfl1PP()RTf�NITV'lOflIDUNYI)1!RC�ONSTNI;CfInNPAOJffT _
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. �.. �' ��'�'�°��,,s�t'�,�;,^�$i �'s.�, x .a�°"'{ ���. 'i.,rz..h ,��.h x,�'+rn^'�,.�' ,K �G� s,.. . . ,'-tF�:z
5803 Shores Drive (763)639-7229
Brooklyn Center Mn 55429
cusroMErt: Richard Smaller
Name Lic#BC631854
Address 930 Marshall Ave May 20,2013
City,State,ZIP StPaul Mn 55104
1235
SERVICE ADORESS:
Same Same as above
�[em �ESCRIPTiON UNR PRICE .�IMOUNT
Replace 2 solid oak doors in front entry.replace jambs and tnm 53,675,00
with comparable materials,stain.vamish to match exisiting wood
work.
SUBTOTAL 3,675.00
TAX
FREIGHT
�3.675.00
DIRECT ALL INQUIRIES TO: �AAKE ALL CHECKS PAYABLE TO: aAV n-ns
Merlin Pettigrew 8CP Contractors Inc 1MOUNT
�763)639-7229
�mail MerlinPettigrew@gmail.com
1NK YOU FOR YOUR BUSINESSI
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