Walsh TILTON �c DUNN, P.L.L.�����`��D
ATTORNEYS AT LAW ��� 12 2013
_ 2220 US BANK CENTER
101 EAST FIFTH.,STREET CITY CLERK
ST. PAUL, MINNESOTA 55101
(651)224-7687 'AL50 ADMITTED IN WISCONSIN
WILLIAM L. TILTON't FAX(65U 224-0239 _"ALSO ADMITTED IN MASSACHUSETTS
GEORGE R. DUNN" "'ALSO ADMITTED IN NEW YORK
MICHAEL J. GROSS• ' •AL50 ADMITTED IN ILLINOIS
tCIVIL TRIAL SPECIALIST, CERTIFIED BY
July 11� ZO13 MINNESOTA STATE BAR ASSOCIATION
City Clerk NOTICE OF CLAIM
15 VVest Kellogg Boulevard ,
310 City Hall
Saint Paul, MN 55102
Re: Our Client: Thomas M. Walsh V
D/O: 3/24/12
Dear City Clerk:
We represent Thomas M. Walsh V, who was in;ured on 3/24/12 while participating in an on-ice event between the
�ne an� �ra periods of an NCAA West Regional hockey game at the Xcei Energy Center. Enclosed please find a
copy of the Notice of Claim form. Please direct all future commur�ication and correspondence to my attention.
In brief, our eiient, who was 19 years �ld at the time (DoB: 5/6/92), was put in a"hamster ball,"which is an.
enclosed inflatable, plastic bal� filled with air, and was �iven no instructions from staff regarding safety. All he was
told was to try to run around a track in a clockwise fashion and then run his hamster ball into his friend, who would
be going around the same track in a counter clockwise direction in another hamster ball. After crashing into each
other, they were then supposed to head to the finish line.
Unfortunateiy, as a direct result of the lack of instructi�ns on how�o safely move in an enclosed inflatable ball
while traveling on ice, Mr. W alsh ended up suffering a shoulder fracture and other damages when he stuck out his
hands tQ support himself as he started to fall, was then lifted off his fe�t, suspended over the ice, and fell toward the
ice landing on his shoulder. Had Mr. W'alsh been given any indication from staff that participating in this event was
in any significant way dangerous to his health and safe�y, he would not have participated. Alternatively, if he had
instead been instructed ta crawl on his knees, which wauld have been much safer, he would have done that and,
thereby, avoided injury.
Please forward this letter to the Nlinnesota Wild's, the NCAA's, ax�d the Xcel Energy Center's andlor t��e City of St.
r aul's general liability J premises liability insura�ce camer in order ta have a claims representative contact me at
t�e address and number listed above. VVe will then provide supniemental information in support of our client's
ci�i�Ti as requested in the enclosed Notice o1�e:�laim form. Please also provide us with a copy of the file or other
ci�►cumentati�n a��ailable cuncez-ning Mr. Walsh anri this incident as well as any and all written information
p�rtaining to the hamster balls, including dates af purc:�ase, manufacturer's instructions, warnings, etc. Tha�lk you
tor our cooperation in this matter•. �
rul � urs
Michae ross
MG:nr °
Enc�Cisure
�ECE�/ED
NOTICE OF CLAIM FORM to the City of Saint Paul, MinnesotaJU� 12�013
Minnesota State Statute 466.05 states that "...every person...who claims dumages from any municipality...shall cause to be pres
governing body of the municipality within 180 days after the alleged loss or injury is discovered a notice stating the time,place,��� '"RK
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 compteted. If something does not apply,write`N/A'.
SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK,
15 WEST KELLOGG BLVD, 310 �ITY HALL, SAINT PAUL, MN 55102
First Name THOMAS Middle Initial M• Last Name V�IALSH V
Company ar Business Name C/O TILTON & DUNN, P,L.L.P. , ATTORNEYS
Are You an Insurance Company? Yes/� If Yes,Claim Number? .
StreetAddress 101 EAST FIFTH STREET, ISUITE 2220
City SAINT PAUL State I"IN Zip Code 551 01
Daytime Phone(6 51; 2�24_ 7687 Cell Phone( ) - Evening Telephone(_) -
Date of Accidend Injury or Date Discovered 3[24/12 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.
SEE ATTACHED LEITER. THIS ANSWER WILL BE SUPPr.F�n,
I
�
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 damag�d�y a pcthc�le o:cca.�.it:,r.:�.F tha�t�e;; ❑ :VI}°v�hicle v✓as damaged by a piow
❑ My vehicle was wrongfully towed and/or ticketed � I was injured on City property
O Other type of property damage—please specify
❑ Other type of injury—please specify
In order to process your claim vou 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
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
• Injury claims: medical bills,receipts RECORDS WILL BE SUPPLII`9IIV'I'ID.
�Photographs are always welcome to document and support your claim but will not be returned.WILL BE
SUPP�ENIFN't'ID
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—nlease comulete this section
Were there witnesses to the incident? Yes No Unknown (circle)
Provide their names,addresses and telephone numbers: THIS ANSWER WILL BE SUPPL�ITID.
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.XCEL EIVERGY CENTER
AREL�TA ADDRFSS: 199 WEST I�LL(X'�G ARD ST. PAUL Nll�i 55102
Please indicate the amount you are seeking in compens tion or what you would like the City to do to resolve this claim
to your satisfaction. THIS ANSWER WILL BE SUPPLIIKII�ITID.
Vehicle Claims—ulease comulete this section � check box if this section does not apply
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? SEE ATTACHID T.F�T�i�:R.
What part(s)of your body were injured? SEE ATTACHED LETTER THIS ANSWER WILL BE SUPPLENIENTID ,
Have you sought medical treatment? Yes No Planning to Seek Treatment(circle)
When did you receive treatment? 'PHIS W�LL BE SUPPLII�1'I'ID, (provide date(s))
Name of Medical Provider(s): mHTS ANSWFR WTT T RF STiPPT F'MF'N'PFn
Address Telephone
Did you miss work as a result of your injury? Yes No �IS ANSWER �n1ILL BE SUPPLII�VTED.
When did you miss work? (provide date(s))
Name of your Employer: __
Address _ ___ Telephone
� Check here if you are attaching more pag�s to this claim form. Number of additional pages�.
�
By signing this form,you are stating that all infbrmation 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 pros tion. Date form was completed 7/11/13
Print the Name of the Person who Compl e s For • I GROSS ESQ.
Signature of Person Making the Claim: � " � ` M�
Wo�-�`a��
Revised February 2011