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Odell, Logan 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 about:blankSaint 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: _____________Logan_____________ Last Name: ____________________Odell__________________ Please Indicate Your Pronouns: ☐ She/Her/Hers, ☐ He/Him/His, ☐ They/ Them/Theirs Company or Business Name: ____________________________________________________________________________________ Is this claim being made by an Insurance Company? YES / NO If yes, what is your Claim/File Number? _________No____________ Is this claim being made by an Attorney? YES / NO If yes, what is your File Number? _______________No__________________ If yes, provide your Insured’s/ Client’s Name: _______________________________________________________________________ </ Street Address: ___________________1858 37th st NW Apt C __________________________ City: ______________________Rochester__________ State: ___________MN_____________ Zip Code: _______55901_______ Daytime/Work Phone: ___________507-718-9660_______________________ Cell Phone: _________507-718-9660_____ Date of Incident or Date Discovered (Must Complete): ________02/21/2026___________ Time: _________11:15 am____________ Please state, in detail, what happened that prompted you to file a Notice of Claim Form: This is SGT Logan Odell. During the February Army Reserve drill weekend, I was responsible for picking up a soldier from the Minneapolis–Saint Paul International Airport. I volunteered to use my vehicle, a 2018 Ford Fiesta SE and went to pick the soldier up with a battle buddy NCO with me. At approximately 11:00 AM, I picked up the soldier at the airport and began driving back to Arden Hills, where our unit is located. While traveling on 7th Street West, I was driving in the far right lane of a two-lane road. There was a vehicle directly in front of me and another vehicle in the lane to my left. As we were driving, I encountered a large pothole in the middle of the roadway. Due to the traffic around me, I was unable to safely maneuver around the pothole without creating a potential risk to the safety of the soldiers in my vehicle and surrounding drivers. The incident occurred between the Highway Motel and 7th Street Storage. Approximately one minute after hitting the pothole, the tire pressure warning light appeared on my vehicle’s dashboard. I pulled over at approximately 865 Dealton Avenue and contacted roadside assistance. Roadside assistance arrived at approximately 12:15 PM. After inspecting the vehicle, it was determined that the tire was not damaged; however, the wheel rim had been bent due to the impact. The spare tire was installed, and I was able to continue on my way. Please state why or how you feel the City of Saint Paul is responsible for your Damages? ______City of Saint Paul is responsible for maintaining that road as clearly stated by MnDOT as you guys are responsible for maintaining that roadway for potholes. 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? YES / NO If yes, please provide the police report case number: ___________________________ If yes, what law enforcement agency responded? ____________________________________________________________ Where did the incident take place? Please provide a street address, intersection or name of city park or facility: On 7th St W in Saint Paul, MN. It would be on the right side of the two lane road of 7th St W very close between Highway Motel and 7th Street Storage business and U-Haul business. I was heading towards 7th St W and ended up pulling over because of the bent rim on 865 Dealton Ave, Saint Paul, MN 55116. What would you like to see happen to resolve this claim to your satisfaction? I want to be reimbursed for the new wheel rim I had to get replaced for a total of $235.00 at my dealership. (Not the local taxes paid though). Were there witnesses to this incident? Please provide names and contact phone numbers: SSG Corbin Dit Lacroix, Trevor and PFC Ahrianna Joseph. I don't know that information and I don't believe I need to request that information from them unless necessary as that is their personal information especially since they’re military. 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? _____________________________________________________________________________ Did you go to the emergency room or urgent care? YES / NO Where? ___________________________________________________ Was medical treatment received? YES / NO Where? ________________________________________________________________ First day of medical treatment? _____________ Are you still receiving medical treatment? YES / NO Did you miss any work as result of this incident? YES / NO Employer(s): _________________________________________________________________________________________________ How much time have you missed from work? _____________________________________________________________________ If you are submitting other documents, please state what you are attaching and how many pages: I am submitting 2 Tire Rim Photos, 2 files for the invoice repair, 1 repair receipt, MnDOT Claim file as additional information, and letter from MnDOT stating the road the damaged occurred on is handle by the City of Saint Paul. 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: _______Logan Odell___________________ Signature of Person submitting this form: ___________________ Relationship of person signing to Party making the claim: _______Myself_________________________ Date document is being signed: _____04/02/2026________________ Revised March 2023