Claim by Progressive Northern Insurance CoTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL ,
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
August 11, 2009
Claim Against the City of Dubuque by Progressive Northern Insurance
Company on behalf of John and Cynthia Walker
Date of Claim
Progressive Northern
Insurance Company
08/10/09
Date of Loss
06/19/09
Nature of Claim
Vehicle Damage
This is a claim in which claimant alleges that the Walker vehicle was rear-ended by a
City of Dubuque Police 2007 Ford Expedition as Cynthia Walker was turning onto
Locust Street from Charter Street.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Terry Tobin, Acting Police Chief
Progressive Northern Insurance Company
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL tsteckle@cityofdubuque.org
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CLAi~A AGAINST THE CITY iDF DUBUQUE, ICIWA
~' ,~~ i i ~-' .-
This written report constitutes your claim against the City of Dubuque, Iowa. You should complete this forte in~fi]11 i3ntt'
attach any additional information that supports your claim. L~i,.1u~;;t:;.1=1~ lr'~
The claim must be filed with the City Clerk at City Hall, 50 West 13"' St., Dubuque, IA 52001. It will then be referred to
the appropriate department for investigation and to the City Attorney's Office. 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 Gaims is made by the City Council. No employee of the City of Dubuque has the authority to
make any representatiory~to you as to whether your claim will or will not be paid.
1. Name of Claima t: ~(~GC'i rf b Sj V~2_ 1 ~' D r~-j}'(~U-~r~ /~r5 ~i~ ~1"~s~e _ ~ ~~~1 ~. ~~ir/,~4t~y~
2. Address: ~C ~U~c O ~ ~~C l ~~Pi'v{"(Ct.~.~ 0 /~l ~L/l0 /
3. Telephone Number. / ~~7 (~ ~~ ~' ~~ ~ ~ ~L~ `Z~ ~.=
4. Date of Incident: (,^ ~1 ~ _G `~
5. Time of Incident: ! (J ~ (~ '~ ~~ !! n
6. Location of Incident (Be specific):
7. Describe the 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.)
8. What were weather conditions like?
9. Give name and address of any witnesses: ~o r~u._
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries.)
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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.)
~l~ sti ~ J:-C '-f-~ Tt' ~' /- c` ~ U ~~i.; < Lz ~ ~ ~' P ~3 ~-i• r~ '~
i3. What other damages do you daim, if any?
i4. Have you been compensated for any part or all of your daim by any insurance company? {If so, give name and
address of insurance comoanv and amount oaid 1
16.~W,~hy do you daim/ the City of/D~ubuque is responsible? ~/~)1~7~'C ~ ~ f '~ L'~
~f~ l~~(J! ~ FTr~-~1~1 /l.'Y?~ ~'r ~Oc 1~r9if~` ~~r. rC /~ .~G~;~-P ~l.S ~-/i C ~'
17. Have you made any daim against anyone else for damages as a result of this inddent? {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 t ' `t day of ~-I,t~1,1 ~- 20 ~~~
(Signature) (~°J i~.I~s'~`~. ~v c,`/h ~S ~ -~ ~~s~~ .1v~~1 ~ ~~tt l~~(~-
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c. rrr ~_ ~'~o r•r, -s
{Print Name)
15, What amount do you daim from the City of Dubuque? ~, / 7 y L~
6,
Correspondence Only
P.O. Box 89440
Cleveland, OH 44101
Phone: 877-818-0139
Fax: (888} 792-5922
08/04!2009 02:43:00 PM
To: CLAIMS HANDLER
Company: CITY CLERK'S OFFICE -CITY OF DUBUQUE
Our Insured: JOHN L WALKER
Our Claim#: 09-2322360
Date of Loss: 06-19-2009
Your Insured: KURT ROSENTHAL
Your Claim/Policy#: UNKNOWN
Total Subrogation Balance: $2,944.06. This includes our insured's $100 deductible. We are seeking
reimbursement at 100%, for a total of $2,944.06.
Please take this as formal notice of our subrogation rights with regards to the above captioned claim.
We have completed our investigation into the facts of the above captioned loss and find that your
insured was the proximate cause of the accident.
Please make draft payable to "Progressive Northern Insurance Co as Subrogee of JOHN L
WALKER", and remit to:
Subrogation Payment Processing Center
24344 Network Place
Chicago, D 60673-1243.
if you need additional documents or information, please fax your requests to 888-792-5922.
Thank you for giving this matter your immediate attention. We look forward to receiving your
payment soon.
Progressive Northern Insurance Co
Carne Moms
Tel 877-818-0139 ext 37096
Carrie_M Moms@Progressive.com
PLEASE INCLUDE THE PROGRESSIVE CLAIM NUMBER
D9-232236D ON ANY AND ALL CORRESPONDENCE
08/04/2009 09:02 FAX PROGRESSIVE 1~j402/002
Jun 19 09 11:370 p 1
~, Driver informs#ion Exchange Report
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PAGE 2!2 t RCYD AT 8!4(200910:56;14 AM (Eastern Dayligf~ Timed t SVR;SRRFAXP118 t DN~:13654 t CSID, t DURATION ~mm'ss);00.30
August 04, 2009, 14:40:39
CMSD2340 /CMSM2340 P A C M A N AUG 04 09 - 14:40
OPID: CMF0017 CLAIM PAYMENT INQUIRY TERMID: ?055
INSD: WALKER, JOHN L POL: 75 282610 -8
DOL : JUN 19 09 IA-IASEFO-GRP- CLM: 092322360 ACTIVE REP: T HAMILTON
PAY TO THE ORDER OF: TOTAL DRAFT AMOUNT: 2,844.06
LINE 1: BRIMEYER AUTO BODY INC - DUBUQUE
LINE 2:
LINE 3:
ADDRESS: 10709 COLLISION DR
CITY: DUBUQUE ST/PR* IA ZIP/CPC: 52001- CNTRY* USA
IN PAYMENT OF: REPAIRS - COLL, Ol MITSU MONTERO 4X4SW
1099 ? N FEDERAL TAX ID: LAST UPDT REP: SXF00.66
CDS CODE * EFT TRACE #: 710440833 ISSUING REP: S FEUERBACH
BANK CODE* CTB ISSUE DATE : JUL 19 09 APPROVED BY:
STATE * IA AREA * REVIEW DATE: 00 00
STOP RSN * DRAFT # : 762922253 REVIEWED BY:
COMMAND:
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