Garrett, Loretta
NOTICE 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 this completed form to the
mailto:Saint%20Paul%20City%20Clerk’s%20OfficeSaint Paul City Clerk’s Office by email (cityclerk@ci.stpaul.mn.us), fax (651-266-8574) or mail addressed to “Saint Paul City Clerk, 15 West
Kellogg Blvd., Suite 310, Saint Paul, MN 55102”.
Claimant: First Name: ________Loretta______ Last Name: ____Garrett________
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? NO If yes, what is your File Number? ____N/A____
If yes, then provide your Insured’s/ Client’s Name _N/A______________________________
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Street Address: _1691 Nevada Ave E_________________________________________________
City: ___St. Paul______________________ State _Minnesota__________________ Zip Code ___55106__________
Daytime/Work Phone (952) 245-0367________ Cell Phone _ (952) 245-0367______
E-mail ________loretta.garrett@hotmail.com________________________________________
Date of Incident or Date Discovered (Must complete) 2/4/2026Time __1 p.m.__
Please state, in detail, what happened that prompted you to file a Notice of Claim Form. __I live off White Bear Ave and I’m consistently being made to drive over city neglected potholes,
which appear to stretch from North to South. This stretch of road is a divided two-lane city street, and the potholes are unavoidable and need to be repaired immediately. <On 2/4/26,
while driving on White Bear Ave, between Barclay and Larpenter Ave, I encountered multiple potholes throughout the stretch of my drive. My front tires took brutal dips during a ride
through a patch of potholes on White Bear Ave. After parking my vehicle, I noticed damage to both front tires on my vehicle.
Please state why or how you feel the City of Saint Paul is responsible for your Damages? _I’m an East St. Paul resident and have noticed an excessive number of potholes that form on
White Bear Ave, yearly. As of yesterday, 2/11/25, the streets remain riddled with potholes. Before the pothole damage to my vehicle on 2/4/26, my tires were inspected at the BMW dealership
on 1/27/26 and was noted only as having low tire pressure. On 2/4/26, while driving on the stretch of White Bear Ave between Barclay and Larpenter, I encountered a barrage of potholes
that caused my two front tires to rip at the seam. Because of this, I had to buy four new tires. The City of St. Paul is responsible for the damage to my tires, because it has not done
enough to mitigate the potholes located on White Bear Ave.___
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.
☐ Property damage: please provide 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.
Continue to page 2 of Notice of Claim Form. Failure to complete and return both pages will result in delays.
This section must be completed for all claims.
Is there a police report for this incident? NO
If yes, please provide the police report case number: _N/A__
If yes, what law enforcement agency responded? _N/A_
Where did the incident take place? Please provide a street address, intersection or name of city park or facility.
The damage occurred on both Barclay and White Bear Ave (across from the community center) AND Larpenter and White Bear Ave (by Walgreens).
What would you like to see happen to resolve this claim to your satisfaction? Because of the damage to my front tires and the associated costs to repair the damage, I would like to be
reimbursed for the total amount paid for the four new tires (please see the attached receipt). In addition, I believe the City of St. Paul should begin to repair all potholes located
on the entire stretch of White Bear Ave from Hwy 36 to Hwy 94.____________________________________________________________________________________________________________
Were there witnesses to this incident? Please provide names and contact phone numbers: </w:t></w:r></w:sdtContent></w:sdt><w:r w:rsidR="0031571E" w:rsidRPr="00 N/A
For property damage claims, including vehicle accidents.
Your vehicle’s information: Year __2022___ Make _BMW____ Model _228i xDrive______ Color Gray____________
License Plate # _JJW 896_____ State vehicle is registered in _Minnesota____
Registered owner of vehicle __Loretta Garrett___ Driver __Loretta Garrett___
Area(s) damaged _Driver side front tire and passenger side front tire__
If a City vehicle was involved: License Plate # __N/A___ Color __N/A__
Was there City insignia on the vehicle? NO Driver’s Name </w_N/A__
Other property damaged: __N/A__
For injury claims of any type.
What part of your body was injured? _N/A___
Did you go to the emergency room or urgent care? NO Where? __N/A_
Was medical treatment received? NO Where? </_N/A__
First day of medical treatment? ___N/A__ Are you still receiving medical treatment? NO
Did you miss any work as result of this incident? NO <
Employer(s) _N/A__
How much time have you missed from work? _N/A_
If you are submitting other documents, please state what you are attaching and how many pages. _I am submitting the claim form (2 pages), the dealership invoice (3) pages, the receipt
(1 page), and four photos of the damaged tires.________________________
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: __Loretta Garrett_____________________________________________________ <
Signature of Person submitting this form: _______________________________________________________
Relationship of person signing to Party making the claim: SELF
Date document is being signed 2/12/2026__
Revised March 2023