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Worthy R�CEI\/ED NOTICE OF CLAIIVI FQRM to the City of Saint Paul, Minnesa�� 12 �3 Minnesota S�ale Sianue 466.05 s�atc�lhni''...every person...wlTO claiin.c damu,�es from an� municipcditv...shall cuu.��e 1��be pr o/�'�( pY go��eninz,�boch�n(�he municrpulrh ti�atlrm��days after d�e nNe,�ed los.c�n�irtjury is drsco��ered n notice stnlin,�rhe timc,�� c,�ct td VLERf� circuntslu»c��sth'",-' and the nmount o/�cnmp��rsatiorT or other relief demnnded.° � Please complete this form in rt�ertti��'��learly typing or printing your answer to each question. If more space is needed,attach additional sheets. Please nofe�hat 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 11� � �.n Middle Ini[ial' I�� Last Name � ��' Company or Business Name Are You an Insur<tnce Company`? Yes No If Yes, laim Number? Street Address � � S � �-`�l � Ciry �./ �cl �� Y� S te �, � � Zip Code��`3� �i Daytime Phone(lO��_s�Cell Phone(�3�)� /�J Evening Telephone(�� ) �l - �� 0�� Date of Accident/Injury or Date Discovered b ��-�� Time ��-V� am/� Please state, in detail,what occurred(happened),and why you are submitting a claim. Please indicate�or ho�wyou feel the City of Saint Paul or its employees are involveli and/or responsible for your damages. i Q. e.- � �r C, /'^ (�`�' � �� I i � � I Please check the box(es)that most closely represent the reason for completing this form: �� 1 My vehicle was damaged in an accident ❑ My vehicle was damaged during a tow ($J '_VIy vehicle was damaged by a pothole or condition of the sU�eet ❑ My vehicle was damaged by a plow ❑ My vehicle was wrongfully towed and/ar ticketed s in ured on C' y property f �� Other type of property damage—please specify ��-�1 L.�� m4 � � ( f��/� h ❑ Other type of injury—please specify GM � �%►►�+ L �/ n b�G`'v � � f � `" �l� �f4�cS�Sutr� In order to process your claim vou need to m ude copies o a applicab e ocumen � ✓� ` � a 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 q- copy for yourself before submitting your claim form. c�'�Z!l,M� 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 � andlor receipts for the rzpairs; 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 retuimed. S �� Page 1 of 2—Please complete and return both pages of Claim Form �t--I-��(,�m�fi � 1 IOZ,�.�hn�qa3 pasina� :m�e17 aq;�u�x�y� uos.�ad 3o aan;�u�►S � �� M 4�' 9 'wao,�s�q�Pa;a�dmo7 oyn�uosaad a��3o auie�aq;auud � d � I pa;a�diuoa s�M wao3 a�ea •uoynaaso.rd uz��nsa.r un�u�z�rja as�v,�'n�u�zu[qns � ) i _ ' ' l , •passaao.rd aq�ou 11iM suiaof pau�isun •a�pa�MOUa�.rno�'fo � �saq a�� o��a.r.roa puv an.r�si paJnno.rd anvz/ no�C uo?�vur.ro�'uT 11v�nz��u1�n�s a.rn no�'�uuof s1��u1u�1s�'g '' • sa�r.d ��uoi�►ppe 3o aaqu�n� •iu.io3 u�ie�a siq;o;sa��d a.�oui�uiqae;;e aae no�f 3c aaaq�aaq��; ' auoqda�a�, ssaapp� :la�oidwg.►no�C�o au►�N ((s)a��p apinoad) � ��.�onn ss�u� no�C p�p uaq� o� �a,� ��.�nfui.mo,i 30�lnsa.�e s��.►om ss�u� no�C p�Q auoqda�a�, � ssa.�ppd :(s)aap�noad ��pay��o au�� ((s)a��p ap►no.rd) �,auauaar.a.�a ania�aa no�C p�p uaqM ' (a��.u�)�uau►�r,aaZ�aas oa�uiuu�jd o� sa� �,�uam��aa1 ��[pau� ay�nos no�C an�H '�� -� � �,pa.infui a.�am �Cpoq ano�C;o(s)�.��d�eyM �� pa.�nfui'no� a.�ann nnoH j ��ou saop uoia�as siya�► xoq .y�ay� p , uo�aas s�q;a;a� woa aseaj –su��ej� an,uj pa�r.ui�Q r,a.�d � –(auz��s�aa�fojduig�iai�)a��iyan {o.�an►.►Q i .rojo� a�eas aaquin�aae�d asua�i� �apoyv a�r.y� zr.a� :a��yan �Cai� �,1��Y✓ '�� (� , — J � -�°��pa�r.tur.Q�a.�d -, a��►qan ;o.�ania4 � � -� .�aump pa.�aasi�a� � �l a°to��a��aS 2 �� g aaq�un� alr.[d asua�� £1'� Q S � '7 IaP�W � a�r,y�—��.►�a,� :aj�►yan.�no� � �aou saop uoq�as siya�i xoq��ay� u t�aas s►q�a�a� u� a as�a� –sui� i��a��qaA � � �� s b� � �� .�� : � �y�� 7t i � -s - �-" � � � _ •uoi��s►��s 1 o�C oa a" 0 S � � y� {� UIILjJ�y1 anjosa.� oa op ol�C1��a4� a�l!I Pinom`fio�C lr,y�o o�a� aduio out�'ui�a�� a� lunouzr, aya a1��►pu� as�ald .ui�a�r.ip�y �11� ` .mssa�au�� •ajq�s � . ��aq aspa�d ��aa`�a�utpu�j asasoj� °,C1�j1��3.�o�ar.d;o awr.0 `uoil�as.iaau► `aaa.ris ssoa�`ssaappr,�aa.��s apino.�d �,a�e�d a��1�anfu��o auapi��r aq�pip a.�ayM � � � �#aaodaa.ro#as��i�l� �S�' � � -7 �,C�ua�r,ao luawa.�r.dap 1�ym `sa�C 3I (a��.r.�) umou�un � sa� �,�1a11��luau►a�ao3ua m�j.�o a��jod ay�a.�a� � w�.�� S :s.�aqu�nu auoyda�a�pu�sassa.�ppe `sawr,u.naql ap�no.zd _ (aj�ai�) umou�un o� sa� �,luapi�ui aya oa sassaul►nn a.taqa ataM uo�;�as siu;a;a� uio�asea� –su�i�� I� •ui�e��.�no,f 30�u��pu�y aq;ui�f�tap ui;insaa ��n�sa�ed q�oq u.�n�aa pue a�a�dmo�o;a.�n��e,� Attachment (A) To: City of St Paul From:A1 Worthy 2404 Shetland Dr,O'Fallon,MO 63368 Cell#636-248-3753 Re: Claim due to hitting a manhole On Friday night June 21$`at approximately 22:00 I was traveling on Ruth Street and right befare Lany Ho my left front wheel hit a manhole cover. The manhole cover was missing the top cover.We later found out from a resident at 62 Ruth Street and from Fran and his co-worker,both City Sewer employees who came to the sight,the water pressure from the storms blew the top off. j We were told we got off easy and very lucky that the top didn't hit us like it has happened in the past.My left front tire blew instantly and I was able to safely pull the car over to the side of the road. I sustained damage to the left wheel,tire,and my alignment. I feel the City of Saint Paul is responsible because the anhole covers should never just blow up from the ground no matter how strong the stoc�is are.I was also told this is a systemic problem in this azea.The night of ow incident;Fran and his co-worker left our scene to go and replace another seven more manhole co�ers that had blew off in the immediate area. , I Attachment�('! �Deieted:(c___ __ _�J Witnesses: , ...,_,__ ., � �• � �Deleted: ) � --- 1. Cintra Worthy lf��b-248-03901 \e� York, NY - __ _ _ _ . _ . —.- passenger in the front seat also help the resident cover the \Deleted:(636 2. BrianalWorth u Ci3G 233 7713 ul� �it the hole. - � - " - - P - _ ---.. ( y �_____- ) �2 Shetland Dr. �Deleted:) New O'Fallon, MO 63368 I ; } - � �� _�. _� -.�.. � 3. Resident at b2 Ruth St. - he had j�kst�id��en i11S �Deleted:(636 j , ..� �.. • : _ ' z?� motorcycle through the area and the manhole cover was �peierea:�oae still covered. The male resident and my daughter Cintra `- - -�-- J were the two people that replaced the cover of the manhole. 4. Fran & Co-Worker- Both arrived around 22:42 and � witnessed the damaged to my car. Talked to the resident at 62 Ruth, remove the cover to take pictures, and give my daughter Cintra this number (651-266-9850) so we call in and start the claim process Monday 6- 24-13. ( 5. Lucy Zanders- 9 Nelson St. ,(6�1-739-8486) ..� � . _ _ _ _ �Deleted:(651 � Finally,the amount I'm seeking in compensarion is as follows: Receipt#1-$218.54—Mercedes of Maplewood Receipt#2-$ 168.72—Discount Tire Receipt#3 -$13.39—Discount Tire 159.95—Alignment Cost waiting to be done. TOTAL: 560.60 i A1 Worthy 636-248-3753 i V v - SALE � � � MERCEUES BENZ OF ST PA � 2780 MAPLEWOOD DRIVE 3enz of Maple�ood Porsche of St. Paul � MAPLEWOOD. MN 55109 TID: 00003470564 DATE: 0622i13 �sbenzofmaplewood.com www.porscheofstpaul.com / TINE: 10:29 AN � MERCHANT u: 425245659999 7g0 Maplewood Drive • Maplewood, MN 55109 ( , w "c 'hone: (651) 483-2681 • Fax: (651 ) 766-2323 �`� �C zzzzzzzzzzzz4�4 � INVOICE: 0000854432 Toll Free: (866) 695-9777 ' 1 ,,J APPROVAL CODE:02219B \ `�`� SEO: 018 '-�._f �' . `�" � 3218,54 ' `'� 101�L AMOUNI � ��` ,�� CUSTOMER COPY � � �. y / � � �\\. -- - erss�a+n� o�waRRa�T��-- � . Any warranties on the product sold hereby are those made by ihe manufactur�The sallar hereby exp ssly isclaims �II rranties,either express or implisd, f tuding a�y implied warranty of inerchantability or fitness for a particular purpose, and the seller neither as es nor uthorizes,any other pe on to assume for it any liabi' in connection with the sale of said products. DATE ENTERED YOUR OFDER NO. DATE SHIPPED tNV010E DA IN ICE ' � 22 JLTN 13 22 JiJN 13 22 I 13 � Nu BER 854432 � o ACCOUNT NO. P92 H � PAGE 1 OF 1 � "� � CREDIT CARD SALE P � a� \`` � T T � ` � O O � j SHIP VIA SLSM. /L NO. TERMS F.O.B. POINT ^ � 6 C EDIT CP�RD T MAPLEWOOD NI1�I - > PA:RT NQ� : D!ESCRfif'T#O �1ST < NET > i41VIEyU1tIT 0!', �—g-4�3—f351.'7 ' TZRE CO PC 187.58 I76. U0 176.00 0 354055 B—Ol NIKE D 89. 00 10 . 00 30 . 00 WE ACCEPT RETURNS IF... IT HAS BEEN LESS THAN 30 DAYS SINCE YOURPURCHASE THIS INVOICE IS - � PRESENTED PARTS AREIN ORIGINAL UNDAMAGED PACKAGE SORRY- NO RETURNS ON SPECIAL ORDER OR ELECTRICAL PARTS FROM ALL OF US AT MB OF MAPLEWOOD THANK YOU FOR YOUR BUSINESS PARTS 206 . 00 YOUR SALES REP, SUBLET S�O 30% HANDBNG T ROGER PRIHODA , FREIGHT 0 . 00 CHARGE SALES TAX 12 . 54 CUSTOMER'S SIGNATURE x rora� ' ais .s4 PARTS HOURS: MONDAY- FRIDAY 7:00 am - 6:00 pm SATURDAY 8:30 am - 12:30 pm All parts new original equipment unless otherwise specified .,�,,,�„ ---------� ........ � D�scouNt� � � � �� T 1 R E ;�.�� discounttire.com ' DATE: @E,—��—��?i�� TI.h?E; 1�?;��c7 f'�M ' . . - . .- . .- . . I L•tC'�?TN`r' �a±1_EI`i `�.�1L hiEl�GEDf�S BEhJZ M1V1�1 t�5 I c.4E%�4 �t-IE?t�P1D L?R C354?� SEDf'lh�� L5?� !�lHITE PEaF f;�a'EC�lUE h�� i 17"PFaSE 2'c�4 CI-IAS I� h1�?�'LE41t70D hfhl �.=�t�+9 D FRLLQI� I+10 E,3�6B ' �'H�PJE: b51-7;.�—��67 I �.Hi ��-LtI'L�Ji�J'' CARR`r OUT =39 'r'IA LEE � TC�P..�L�E SPEC�'� 1ti�t .,IORi�: QRL�ER# � i .� . . . . I I � � � E�1��:� P�aRl�t !. 1_;:x;;. 5 �—i i� �cS A�J�JA�1�I P,S6 = Gr., 56 �.;Oh1 . c��t 154.?.��' I�E�!. 4�� G�RRRF'�NTY': LIcETIl�1E STRUGTlJRRL Rh1D 1 YENP, �IPdISN i COMh1E1VT: U�E HIS C1Ehi SEP��^OP, FR�I+? THE HIS t•?HEEL COPiMEnlT: B�LT �'�;TTERPI: �-11L' 8�5i�7? P�?ht �c� i�+Xi e ��;�� 5D B�LT 3NSTL k.T 17�18SD—�:t'�L� ELT p�� JJ.4�� .�iQ� '?9�-�� ±RI�? 1 #�u��i E T�—�rti� RED Tf'MS REBU I LD K I T .4�Q� 7.50 i� 54� � �UBTQTPL: 157. 5�' Tax: lia �� TC?T�t._: 1�8. ?� >t�J� hfi"iTCH: '�' XXl(:�;X?;}:X};�;XX �+i54 1+ifl5TERCARD: 1E,8.7� TE�JDERED: 1G8.?� (?EADE� U?�lA�Jf?II ,aE�LE �� i oo� recydable paper � ��"`�'� LIMITED WARRANTIES ti.�� 'Y,f.,+.'y i�� ;" yf�fti:��:��. s.� r:n..'' �`o 'r' 0�1�r�yi' �i��h��4V �i�� 'J ��90�M��A r�iJ1�46'��;� + �,,,��„,'r,a?r;",,��,r,,s��'r�� r�,trt�� `��s�? Discount Tire and America's Tire Stores �'� ��F� ,r1�'. h ��_ , ��,< . � ,i! � � ^� ELIGIBILII'1-These Limited Warranties appty to all owners of the tire using � -:tiy�� it in noncommercial service,exce t for the Milea e Warran which is limired B s� P �Y 4' �5'N wa: ��I�I�� °'�,''' to the origina(purchaser. � `;�� ,;;\ �` . FO R R E PAI R, R E F U N D O R R E PLAC E M E NT �__..,I" 'pp lypi(E A CLAIM- Present your tire(s)and original sales invoice to any 1 Discount Tire or America's Tire Store.To locate a store you may call 1{88S)774- I � For a fee collected at the time of the original tire purchase or for a fee collected to subject `.'„� 6560,or visit the Discount Tire web sire at www.diswunttire.com.The vehicle other tires to the terms of this certificate, Discount Tire or America's Tire stores will '' on which the tire was used must be available for inspection.You will be asked refund the purchase price and the sales tax,if any,on any tire covered in the event of a :;;;�; to complete the customer portion of the adjustment claim form. ,•,,,�,� failure due to workmanship and materials or a non-repairable road hazard for the service ?.i II of the original tread down to 3/3z inch remaining,or 3 years from date of purchase, .;� WARRAIV'I'Y COVERAGE whichever occurs first.L'pon refund o�credit of sales tax,customer hereby acknowledges '�`%y'! New Tires-Workmanahi p and Materials-If our examination shows i by actual signature or electronic signature capmre such credit or refund.This additional ;;;�� that a passenger,SUV,or light truck tire covered by this warranty has become acknowledgement satisfies a technical requiremrnt in the sales tax statutes and/or %i;;f� unserviceable due to a workmanship or materials defect during the service regulations for man}�jurisdictions that a signed receipt must be obtained upon the refund �,, down to i/i2 of an inch,it will be replaced on a pro rata tread wear basis. � or credit of sales taxes.At the election of the purchaser,we will sell a replacement tire �� to the purchaser at the original price paid for the damaged tire,plus the required sales New Tires-Road Hazard(if applicable)-If o�r examination shows that � ta�c.In the event the co��ered tire is discontinued or unacailable,a tire of similar value will ��0 a passenger.SL V,or light truck tire covered by this warranty has become .y�� unsen°iceable due to a normal road hazazd Ct.e.,non-repairable puneture,w[, ' be substituted. _ '� � snag,bruise,or impact break)during the service down to 3/i2 of an inch,it If in our o inion,the[ire can be safel re aired,we will do so free of char e.The ws[of "�".�� '��l be replaced on a pro-rata[read wear basis. i �i° P Y P S �� this certificate is set forth o�thc receipt issued for thc purchase of tire(s). New Tires - M�eage Warranty (if appGcable) - in addition to the IThis certificare will be honored at any Discount Tire orAmerica's Tire s[ores.This certificace warcanties above, every mileage warianted passenger, SW or ligh[truck dces not cover damage caused by collision,vandalism,chain damage,mechanical defects �ue is warranted to the original purchaser for the specified nurttber of miles of tread w•ear and against normal road hazards for the same mileage (if I� of the rehicle or willfitl abuse.No other propern damage or consequential damage of any �°�3�,'' dPp��cable).If our examination shows that the tire covered by this warranty �nt; y kind is covered by this certificare. ,• has worn down to its tread indicators before giving the specified number '� z�:',;�� of miles of noncommercial service on the passenger,SW or light truck on There will be additional charges ro purchase a new certificate for a replacement tire and � which it was installed,it will be replaced on a pro-ra[a mileage basis. ' to balance a replacement tire. �:;+?;�� '�'�° ATV/1'niler Tires - ff our examination shows that a trailer or A1'V tire By redeeming this certificate,the customer relinquishes the right to any manufacmrer's '-�;;�, covered by this wamanty has become unserviceable,other than by a road warranty that may apply,and Discount Tire or America's Tire may claim for its own benefit .:M1};1;1� hazard,during the three year period following its date of purchase,it will any such manufacturer's wamanty. ==:� be replaced based on a charge of 33%per year or part[hereof of the original ;;��}!� purchase price. � • � • • • ". _`", � �';..y 1 �. _��;'��ij CALCULA7'ION OF REPI.ACEMEIVT CHARGES - Tires are replaced under these limited warranties with a comparably priced new tire at a pro-rata O ' i cost to the customer.Tread wear is pro-rated on the basis that the tire is worn D 1�� ` '�� out when the tcead is worn down to 3/32 of an inch remaining tread groove .,• < depth or to the tread wear indicators on tires containing them.Tire replacement r I �: '��I cost is determined by multiplying the original cost of the tire by the percentage �'.�� : of tread used.For example,if the original tread was ll/32 of an inch,and the � � R � ��,:, i� tire has 5/32 of an inch of tread remaining at the time of replacement, the " �' replacement cost will be 75% of the original cost((11/32-5/32)/(11/323/32) '�"� x 100).The replacement cost for mileage warranted tires is prorated at a set �j'`"' �"�%;;�'� charge per 1,000 miles drivea F.E.T.and state taxes are added to the replacement ' � ��1 ' ��t � N+1�11 11��1 Hrl 1 n1i Nrr < cost.Additional charges for mounting and balancing apply. f,�'o , �y �'j, � ��M,�'�1��A��'d",4��5��,�!��,��i��v,S ih��;�,��,�i��,��i��,rr� ,ti;;'� ��•- ti'��:5�.6 ; . .. �iS�}Jyi PryiO4� � 0 i ♦i v •i �i � i �i v � tip�a.'k.. .o.,. , � ♦ �� d♦ � ♦ ♦ , ♦ ♦♦ � � ♦ ♦ s+.�- :? �`Y.%' �*:f`+3� �:#/ .'�j ��^�j� a`+•'t��ff�� .�. __ I1'EMS NOT COVERED-These warranties do not cover , ��`. _ �—/`�'�/�—i � � The cost of an}�tire indiides an}�wheei weights used in the balancing of the tire. • Use in commercial service such as commereial truck racing,street sweepers,off-the-highway taxi,limousine,or similar service(however commereial service does not include use by[he owner as transportation in his/her regulaz trade or business); T I PS TO I M P R O V E T I R E ' llamage,destmction,or failure due to accident,fire,or vandalism; • Ircegular or premature tread wear caused by improper inflation, M I L EAG E A N D SA F ETY misalignment,imbalance of wheels,or worn out shock absorbers or brakes; • Damage or failure due to non-tire causes such as being run fla[,mechanical � ---- - — - .__.. _ —�-- "--- '..--� -- - - - -- conditio+:-ofthc��eUicac,cvtsfross-a�s�c-lsau+s�-eraa}`s�`�a4usg�--- • Problems related to the appearance of the tire aker the first 10%of weaz. �ROTATE TIRES � REPLACE every 6,000 to 8,000 miles or when wom-out tires when built-in wear bars OR'NER'S Di11'IES-It is the owner's responsibility to: necessary to equalize treadwear. appear across the tread surface. • see cnac me c�res are operaced ac proper�ntiauon,pressure and loads; �REBALANCE � REMEMBER TO RETURN ' Pay applicable taxes and dealer services such as mounting and balancing; every other rotation to promote even to any Discount Tire/America's Tire store ' Remm the adjustable tire and complete the customer portion of the adjustment claim form. tire wear and a smooth ride. tor a tire inspection. DURATION OF COVERAGE-These warranties expire three(3)years from �MAINTAIN AIR PRESSURE � the date of purchase. as recommended by the vehicle or tire manufacturer.Check your air pressure at least �"' 1 � � CONDITIONS AND EXCLUSIONS - These limited warranties are the i exclusive warranties of Discount Tire or America's Tire stores,are in lieu of the once each month when tires are cool. J warranties of the mam�facturer,and set forth the exclusive remedies available to �� the tire usec In the event that the terms of an applicable manufacturer's warranty �MAINTAIN ALIGNMENT exceed the protec[ion given under these warran[ies,Discount Tire or America's Tire stores will honor those terms Discoun[Tire or America's Tire may claim (Front&Rear)replaCe worn SuSpension partS. ` , for its own benefit any such manufacmrer's warranry.These limited warranties C�� '° � d° not provide compensauon for an} consequential, special, incidental or PLEASE DO NOT USE A''R � I i �� contingent damages. Some states do not allow thr exclusion or limitation of � inadental or conse quential dama ges,so the above limitation or exdusi o n m a y any"Fix-a-Flat"type products. Y ` � � � �'-1' not apply to you.Tires presented for a daim remain the property of Discount � �� s� Tire or America's Tire Stores.No representative or employee of Discount Tire or �INSPECT S�� A�e��'� America's Tire stores may enlarge or alter these warranties. tires occasionally for excessive wear,tread coxsm►iER RIGHTS - These um�cea warranties g��e you spe�iec legal or sidewall euts,Of Othef CI0f11290. rights,and you may also have other rights which vary from State to State. i : � �Q� �/f� ' v�scouMt � TIRE '� (��.�JJJ � discounttire.com � ; P,P,TE: u"+�-'cL-'i`?�i�. TIh1L� 11 :47,' 1'1M � . . • . .- . .- . . � i.Jr'pTH�`r r=tLL.L}7 ;�Q�1�: h1ERCEDE� Hc}" ?+1Pah? i<�?5 � i ��4�?!� SHETF3lVD D�t �v5� �EDAN :_�,4.'� �dNITE BEAP, Rb'EP!`{E PJ � �?��BF=?:7E :'�'�=+ rF�:"?�;� i+!a��LE4±C?�i} �+th! �:�i�9 ! �1 F�tLLC1hJ t�t� E,3 ar��? F'HClNE: �_��_�;�J�L'�L��.tJr � �� °�'' 'TA LEE � �;H? 6;-'r=:—�4��t--�%�.��, ,�� Y� i TC1P, !�E S��ECSe 1�►� IJQP,�! QF..PER# � i i .. � . . . � 83�1�� dRi�1 � 14:�;... �=:=�1 L�ALL �E�'tT ��I� Ei`��1LT .Q►� ?. 5� , . �� CDh!h',EnJT: ?xC!LT ��r;-rY�r:r,,': C-1 �� i 51;34 NRh1 i 1�%85D 1-.E�' 1?„'16 L� 7%8 S�'LIP•lE �;EY' .�� .4.�� 5. ��c'� � � ( i I i ; i i i I - �t��r��T:a±� i�a�� -r�a�a x �� -r�i-rf�i_: i�. �� XXXX:�:?�;x;},�;�;4 47�� h1�t�TEf?�r�RL�: 13a 33 TEI+iL�EP,EI;: 13. ?�'� 1�EnL�ER LJI�l�ltJ�IL�-1�LE �� i oo� recydable paper � � ., � � :� ,��%fi;}� x;�. LIMITED WARRANI'IES � �'6�. ' 4 �.�•.f��'r•d ° � ♦�`'�' ♦•� i�� e o�z� �.o��.. 1 � ��'�'�i�'��•��',i".,�.y� .� .. � i�P� :W��4�riCC�P��@AW4�� i�'��ar�r�roia.t�P��4Yr�ti'�,.tMt �h4�.�dM� irr hv'.'•1j � � ^� � r -r �'�W ,��+�tir ,n�H r , e r.� �1 r �+��t'l� �1SCOUIlt TIrC'slll(1 E�11CT1Ca S T1TC St01'CS �� i nt� '�t � �� . a r,v��' +�> �ii� � �: � CERT/F/CATE �s2� ELIGIBI�LIT'Y-These Limited Wpnaoties apply�all own ry of the tire using ,,,,,_ �� ,� it in noncommercial service,exce t for the Milea e Warran which is limited i �"w�ia*=�� „�''ii to the ori inal urchaser. �,��.---- � .Y� � �� FO R R E PAI R R E FU N D O R R E PLACE M E NT =� .;�+ ro Mn�n er.niM- P�esent our tue s ana ori �nai saies;n�o«e to� 1�:�..: , �:,,� Y C) s' Y �,� �=,� Discount Tire or America's Tire Store.To locace a store you may call 1{888)774- 1 i r;, " For a fee collected at the time of the original tire purchase or for a fee collected to subject �,jf�i) 6560,or visit the Discount Tire web site at www.discounttire.com.The vehicle other tires to the terms of this ceRificate, Discount Tire or America's Tire s[ores will °:r',�h on which the tire was used must be available for inspection.You will be asked �e:'v',�� ! �t. - refund the purchase pcice and the sales tax,if any,on any tire covered in the event of a y:.l,f,y to complete the customer portion of the adjustment claim form. ' �*�' failure due to workmanship and materials or a non-repairable road hazard for the service � , � r'�� of the original tread down to 3/32 inch remaining or 3 years from date of purchase �.,5 WARRANI'1 COVERAGE ''�.;`�' whichever occurs fust.U on refund or credit of sales ta�c,customer hereb acknowled es ."'e�� P y g New Tires-Workmanship and Materials-If our examination shows ! } by actual sige�a[ure or electronic signature capmre such credit or refund.This additional -�-�.;.;ti that a passenger,SW,or light truck tire covered by this warranty has become +y'�'�`'�,',� acknowled ement satisfies a technical re uirement in the sales taac stamtes and/or _�-.�:�`'� g q �r,,,!� anserviceable due to a workmanship or materials defect during the service regulations for many jurisdictions that a signed receipt must be obtained upon the refund �r�� down to 3/32 of an inch,it will be replaced on a pro rata tread wear basis. ��• or credit of sales taxes.At the election of the purchaser,we will sell a replacement tire � �;�'��'� , 3',� _-_:,�! New Tires-Road Huard(if applicable)-If our examina[ion shows that to the purchaser at the original price paid for the damaged tire,plus the required sales _�. �i�� '.'� a passenger,SUV,or light truck tire covered by this warranry has become tax.In the event the covered tire is discontinued or unavailable,a tire of similar value will j f�;h;V,+ . M - ,f unserviceable due to a normal road hazard(i.e.,oo�-repairable puncture,cut, be substituted. > �� snag,bruise,or impact break)during the service down to 3/3�of an inch,it i�$ .. �.:i� � "''� If in our opinion,the tice can be safely repaired,we will do so free of charge.The cost of '�*.,.�i�� will be replaced on a pro-rata cread wear basis. [his certificate isset forth on the receipt iscued for the purchase of tire(s). --=-,,;j� New Tires - Mileage Warranty (if applicable) - In addition to the � This ceRificate will be honored at any Discount Tire orAmerica's Tire stores.This ceRificare warrantics above, every mileage warrai�ted�assenger, SW or light truck . dces not cover dama e caused b collision,vandalism,chain dama e,mechanical defects ��'e is warranted[o[he original purchaser for the specified number of miles g Y g �,ss'�`'�,� of tread wear and against normal road hazards for the same mileage (ff > of the vehide or willful abuse.No other property damage or coosequential damage of any : '�� dPP�cablr).If our rxamination shows[hat the tire cocered by this warranty /jn kind is covered by this certificate. � ,,�,� has worn down ro its vead indicators before giving the specified number ! �a�� __„�� of miles of noncommercial sen�ice on the passenger,SW or light truck on There will be additional charges to purchase a new certificate for a replacement tire and : '�� which it was installed,it will be replaced on a pro-rata mileage basis. � � to balance a replacement tire. �� ` = �''j ATV/'Prailer Tires - If our examination shows that a trailer or ATV tire 1 �4 By redeeming this certificate,the customer relinquishes the right to any manufacturer s '- �� covered by this warranty has become unserviceable,other than by a road ��`'" warranty that may appiy,and Discount Tire or America's Tire may claim for its own benefit �r�� hazazd,during the three year period following its date of purchase,it will �,r._ any such manufacturer's warranty. .-:-.4; be replaced based on a charge of 33%per year or part thereof of the original k"'+ <';:�:�'�it urchase dce. ��r;�::_ � • � • • _e�;q�� P P ' ♦+`��,'� CAI.CULATION OF REPI.ACEMENT CHARGES - Tires are replaced 1 'i��i ��r .r under thex limited warranties with a comparably priced new tire at a pro-rata i D'��O =• ,�'\ cost to the customer.Tread wear is pro-rated on the basis that the tire is wom � �ti� � �� ` I out whe�the tread is worn down to 3/32 of an Inch remaining tread groove � � depth or to the vead wear i�dicators on tires containing them.Tire replacement ' y�� ,y1;�,�� wst is determined by multiplying the original wst of the tire by the perceutage of tread used.For example,if the original tread was 11/32 of an inch,and the � • � � R � ��,?'� tire has 5/3� of an inch of[read remaining at the time of replacemeot, the � } . � replacement cost will be 75%of[he original cost((11/32-5/32)/<ll/323/32) � � ' v; x 100).The replacement cost for mileage warranted tires is prorated at a set I YZ� " '� i� chazge per 1,000 miles driven.F.E.T.and state tazes aze added to the replacement 1 1 1 11 111 ` 11; N� �kll� 1�Itl 111�1 1�11 IH'� cost.Addiflonal chazges for mounring and balancing apply. �r.' � �� M��,�� .��i��,�� r`r� , ��,i��.�r�� -��+�� a��T I � �� 'q��R .��h ��r � � �u� w��R ��. �� .Y� ��'��°� A_� �ti�.,i:�d0�,,.4�i�pl��i�J��tihStiW��p�i�ti��ry�N iii�� r�p��p��r��i�i; ��.�" ' � ' �,v.��'-i'._$�1,-' - �' �� f� �'3.�� `-:-��`- r �� ='�� _ % ITEMS NOT COVERED-These warranties do not cover. ,�.' .,r��;��./�^> .��/��/�..?±/\,.--� "�/ The cost of any dre includes any wheel we�ghts used in the balancing of the are. \ �Y • Use in commercial service such as commercial truck racing,street \ � sweepers,off-the-highway taxi,limousine,or similar service(however e� , commerci service does not include use by the owner as transportation in vhis/her ular trade or business); TI PS TO I M PROVE TI R E `�� Da ge,destn�ction,or failure due to accident,fire,or vandalism; egular or premature tread wear caused by improper intlation, M I L EAG E A N D SA F ETY li ent,imbalance of wheels,or worn out shock absorbers or brakes; _ _ — — �• • D or failurr due to non-tire causes such as being run flat,mechanical condiYiea of Yhe vehie{e,cuts from tims or ciiains,or any wlllful abnse; �ROTATE TIRES � REPLACE /� P�oblems related to the appearance of the tire after the first lo/of weaz. � every 6,000 to 8,000 miles or when wom-out tires when built-in wear bars JowivER°s nv'riES-�c„me owner�s respons;biiiry co: necessary to equalize treadwear. appear across the tread surface. � ��. se ac tne cires are operared ar proper int�acion,pressure and loads; �REBALANCE � REMEMBER TO RETURN . ay�le taxes and dealer services such as mounting and balancing; -r v every other rotation to promote even to any Discount Tire/America's Tire store �rn cne aajuscabie c�re ana�ompiece tt,e c�scomer porcion of cne a � tment claim fortn. tire wear and a smooth ride. for a tire inspection. TION OF COVERAGE-These wacranties expire three(3)years from �MAINTAIN AIR PRESSURE � th te of p�rchase. as recommended by the vehicle or tire �! CONDITTONS AND EXCLUSIONS - These iim�ced warrancies are che manufaeturer.Check your air pressure at least � � � � exdusive warranties of Discount Tire or America's Tire stores,are in lieu of the once each month when tires are cool. wananties of cne ma��ea�mrer,and set forth the exclusive remedies available to [he tire usec In the event that the terms of an applicable manufacturer's warranry �MAINTAIN ALIGNMENT � exceed the protection given under these warranties,Discount Tire or America's Tire stores will honor those terms.Discount Tire or America's Tire may claim (FfOnt&R2dr)rBpldCe Wofn SUSpOnslon PartS. -� for its own benefit any such manufacturer's warranty.These limited warranties A�� I� � �+'�� do not provide compensa[ion for any consequentlal, special, incidental or PLEASE DO NOT USE I� ��'�� contingent damages. some states do not auow the exdusion or limitation of � incidental or consequential damages,so the above limitatioo or exclusion may any"Fix-a-Flat°tyP@ P�OdUCtS. \ � ��t ' not apply to you.Tires presented for a claim remain the properry of Discount S+�� Tire or Amedca's Tire Srores.No representative or employee of Discount Tire or ��NSPECT America's Tire Stores may enlarge or alter these warranties. tires occasionally for excessive wear,V@dd � / CONSiTMER RIGHTS - These limited wananties give you specific legal or sidewall cuts,or other damage. � � '� ro rights,and you may also have other rights which vary from State to Stace. � S� SS �� -f��G� �. .� � s\\: Q�� , S: y .cr I Ililli��d°�lil,,,, �� I r k'�I� '° � ��..;: :��:: ��,: �� a ..a� � , � �� , � ��`` "_ �� :; .� �. �. v. r �"u'.: �`.: ! � `�� `y'Y y` ,-� � � !<i Y. 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