Claim by Progressive Universal Insurance Company A/S/O Hein, FlorenceCopyrighted
February 7, 2022
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: A.Y. McDonald Mfg. Co for property damage; Diane Hanson for vehicle
damage; Progressive Universal Insurance Company as subrogee of
Florence Helin for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by A.Y. McDonald Mfg. Co Supporting Documentation
Claim by Diane Hanson Supporting Documentation
Claim by Progressive Insurance Co. / Florence Helin Supporting Documentation
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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This written report constitutes your claim against the City of Dubuque, Iowa. You should
complete this form in full and attach any additional information that supports your claim.
The Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001. It
will then be referred by the City Council to the appropriate department for investigation.
Once that investigation is completed, a report and recommendation will be submitted to the
City Council. You will be provided with a copy of that report and recommendation.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF
THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
Name of Claimant: Progressive Universal Insurance Company A/S/O HELIN, FLORENCE
2. Address: P.O. BOX 94639
City: CLEVELAND State
3. Telephone Number: 877-818-0139
4. Date of Incident: 12-14-21
5. Time of Incident: 1:59 P.M.
OH
6. Location of Incident (Be specific): EAST 13TH ST
Zip: 44101
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you base your claim. If a City employee was involved, give the
employee's name.)
OUR INSURED WAS TRAVELING EAST BOUND ON EAST 13TH ST IN DUBUQUE IA WHEN A
CITY POLICE VEHICLE WITH PLATE # 501905 OP RAT RD BY HELIN, FLORENCE STRUCK
OUR INSURED'S VEHICLE. WE ARE SEEKING REIMBURSEMNT FOR OUR INSURED'S VEHICLE
DAMAGES.
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
12. Was any damage done to property? (If so, describe property and the extent of
damages. Attach estimates of damages or describe basis for ascertaining extent of
damage.)
19 CHEVROLET CRUZE - RIGHT FRONT
13. What other damages do you claim, if any?
14. Have you been compensated for any part or all of your claim by any insurance
company? (If so, give name and address of insurance company and amount paid.)
Progressive Universal Insurance Company P.O. BOX 94639 CLEVELAND, OH 44101 $5,048.10
15. What amount do you claim from the City of Dubuque?
$5,048.10
OUR INSURED WA T RAVELING EASTI60LIND ONhEASTe13THresponsible?
ST IN DUB UQUE IA WHEN A CITY POLICE VEHICLE WITH PLATE #
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INSURED'S VEHICLE DAMAGES.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this 25 day of JANUARY , 20 22 .
Brittanv Wallette
(Rev. 5/18)
Print Name)
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