Davison, MargaritaNOTICE OF CLAIM FORM to the City of Saint 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 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 answers to each question. If you have additional documentation you may add those
documents to your submission. You will not be contacted by telephone unless clarification is needed. The claim process for investigations can take upwards of
four (4) weeks. This form must be signed, dated with all applicable sections completed. Submission is to the Saint Paul City Clerk’s Office. You may email, fax
(651-266-8574) or mail the form. Mailing address is “Saint Paul City Clerk, 15 West Kellogg Blvd., Suite 310, Saint Paul, MN 55102”
Individuals: Margarita Davison, on behalf of her minor child JuVaughn Turner Click or tap here to enter text.
Please Indicate Your Pronouns: She/ Her/Hers ☒ He/Him/His ☐_ They/ Them/Theirs ☐
Company or Business Name: n/a
Is this claim being made by an Insurance Company? No If yes, what is your Claim/File Number?: n/a
Is this claim being made by an Attorney? YES If yes, what is your File Number? 10463-1
If yes, then provide your Insured’s/ Client’s Name Margarita Davison, on behalf of her minor child JuVaughn Turner, courtesy of
their attorneys of record Andrew Marshall, Kyle Willems, and Bryce Riddle, Bassford Remele, P.A.
Street Address: 100 South 5th Street, Suite 1500
City: Minneapolis State : Minnesota Zip Code 55402Click or tap here to enter text.
Daytime/Work Phone (612) 376-1604 Click or tap here to enter text.
Date of Incident or Date Discovered (Must complete) 1/18/2023 Click or tap here to enter text.
Please state, in detail, what happened that prompted you to file a Notice of Claim Form. On January 18, 2023, JuVaughn Turner
was shot in the head by City of St. Paul employee Exavir Binford at the Jimmy Lee Recreation Center (the “Incident”) while Binford
was in the course and scope of his employment and acting under color of state law. Margarita Davison, on behalf of her minor
child JuVaughn Turner, seeks monetary damages from the City of St. Paul for wrongful acts that led to or contributed to the
Incident.
Please state why or how you feel the City of Saint Paul is responsible for your Damages? The City of St. Paul is vicariously liable for
the wrongful acts of Binford because it was negligent when it hired, retained, and supervised Binford. Further, because Binford
was in the course and scope of his employment and acting under color of state law, his conduct constituted assault, battery,
intentional and negligent infliction of emotional distress and deprivation of JuVaughn Turner’s civil rights under 42 U.S.C. § 1983.
Other basis for claims against the City of St. Paul may exist as additional information becomes available.
Please check the reason that most closely describes the reason for your submitting a claim. Please note the documents that will
need to be provided with your completed form. Photographs will be accepted. All documents submitted become the property of
the City of Saint Paul and shall not be returned.
☐ Automobile damage from a motor vehicle accident: please provide two estimates for repairs or actual bill that has been paid.
☐ Automobile damage from a street defect or pothole : please provide two estimates for repairs or actual bill that has been paid.
☐ Automobile was towed and may or may not have sustained damage: please provide copy of towing ticket (if available), receipt
from Impound Lot, and two estimates for repairs or actual bill that has been paid.
☐ Snow Emergency: please provide copy of towing ticket (if available), receipt from Impound Lot, and two estimates for repairs or
actual bill that has been paid.
☐ You were injured during a motor vehicle accident: please provide police report number, details about injury.
☒ You were injured in the City of Saint Paul: please provide police report number, witnesses and details about injury. We are in the
process of obtaining this information. A supplemental notice will be provided once additional information becomes available.
This section must be completed for all claims.
Is there a police report for this incident? Yes If yes, please provide the police report case number We do not have a copy of a
police report at this time.
Revised December 2021
If yes, what law enforcement agency responded? The St. Paul Police Department.
Where did the incident take place? Please provide a street address, intersection or name of City park or facility.
Jimmy Lee Recreation Center, 270 Lexington Parkway North, St. Paul, Minnesota 55104.
Notice of Claim Form, page two. Failure to complete and return both pages will result in delays.
What would you like to see happen to resolve this claim to your satisfaction? For the City of St. Paul to pay monetary damages in
amount necessary to fully compensate the Turner family.
Were there witnesses to this incident? Please provide names and contact phone numbers. We will provide witness information
once it becomes available.
For property damage claims, including vehicle accidents.
Your vehicle’s information: Year ______ Make _________________ Model ____________________ Color ________________
License Plate # _____________________ State vehicle is registered in ________________________
Registered owner of vehicle ______________________________ Driver ______________________________________
Area(s) damaged ___________________________________________________________________________________
If a City vehicle was involved: License Plate # _______________________________ Color _______________________________
Was there City insignia on the vehicle? Yes No Driver’s Name _____________________________________________
Other property damaged: ___________________________________________________________________________________
For injury claims of any type.
What part of your body was injured? Head
Did you go to the emergency room or urgent care? Yes Where? Regions Hospital in St. Paul
Was medical treatment received? Yes Where? Yes. Regions Hospital in St. Paul
First day of medical treatment? 1/18/2023 Are you still receiving medical treatment? Yes
Did you miss any work as result of this incident? No Employer(s) Click or tap here to enter text.
How much time have you missed from work?___________________________________________________________________
If you are submitting other documents, please state what you are attaching and how many pages. A detailed demand letter will be
forthcoming.
By signing this form, you agree that all information provided is true and correct to the best of your knowledge.
Please NOTE that submitting a false or misleading claim can and will result in prosecution under Minnesota Statutes.
Name of Person completing form: Kyle S. WillemsClick or tap here to enter text.
Signature of Person submitting this form: /s/ Kyle S. Willems
Relationship of person signing to Party making the claim: Attorney of Record
Date document is being signed 4/13/2023
Revised December 2021