Claim by Ronald Koehler Copyrig hted
February 1, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Jennifer Connolly on behalf of State Farm I nsurance; Ronald Koehler on
behalf of State Farm I nsurance for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Jennifer Connolly Supporting Documentation
Claim by Ronald Koehler Supporting Documentation
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Providing Insurance and Financial Services : StateF�rm�
Home Office, Bloomington, IL
January 08, 2021
City Of Dubuque S�teFarmaaims
50 W 13th St P.O.Box 52250
Dubuque IA 52001-4805 PhoenixAZ85072-2250
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RE: Claim Number: 13-14M9-74G
Date of Loss: December 12, 2020 ,
Our Insured: Ronald L Koehler :
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To Whom It May Concern:
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We received a claim regarding your 2013 Chevrolet 3500HD. A member of our claim fieam will
review your loss and we'll contact you if we need additional information.
Claim Information
Claim Number: 13-14M9-74G ��
Date of Loss: December 12, 2020 �
Named Insured: Ronald L Koehler
State Farm°Contact Number: ($55) 341-8184
Claims Office Hours Mon-Fri: 6:30 AM -9:00 PM ;
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Sat: 7:30 AM - 8:00 PM
Sun: 8:30 AM - 7:00 PM
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13-14M9-74G
Page 2
January 08, 2021
Sincerely,
Tamika Crayton �'i
Claim Associate
(855) 341-8184 i
Fax: (855) 666-0964
statefarmclaims@statefarm.com
For your protection, when emailing State Farm,please do not include sensitive personal informafion such as Social Security Number,
credit/debit card number(financial accounf number),driver's license number,or health/medical information in an email.Please contact �
us at(855)341-8184 to discuss sensitive information.
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State Farm Mutual Automobile Insurance Company
Take advantage of our self-service options
Go to statefarm.com�to easily review claim status, update direct deposit account information for claim
payments and many other insurance and banking services.
Would you like to receive emails from State Farm?To update your profile preferences, go to
statefarm.com�.After logging in, click on Profile and Preferences on the left navigation panel.
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Ple�se di�ote:Protecting your personal information is importanf to us. You will be asked to{og in with a user
_ name and password each time you access these sites.
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Providrng lnsurance and Financial Services i� ��a�eral,m�
Nome Office, Bioomrngton, !L
January 18, 2021
City Of Dubuque - City Clerk At City Hall Subrogation Services
50 W 13th St PO Box 106172
Dubuque IA 52001-4805 Atlanta GA 30348-6172
RE: Claim Number: 13-14M9-74G
Our Insured: Ronald L Koehler
Date of Loss: December 12, 2020
Your Insured: City Of Dubuque - City Clerk At City Hall
Your Insured Driver: Jarrod Pusateri
Loss Location: 1625 Ashton Place, Dubuque, IA
To Whom It May Concern:
Facts of Loss:
Snow plow struck the insured's vehicle while parked and unoccupied.
It is our understanding that you are self insured. Our investigation indicates you are responsible
for this claim. Therefore, we are seeking recovery from you. This letter is to notify you of our
subrogation claim and request your cooperation in settling this matter.
To assist you in your review, here is a breakdown of the amounts State Farm° paid by Cause of
Loss:
041/045 - Uninsured Motorist BI $
042 - Uninsured Motorist PD $
300 series/400 - Comp/Collision $4,777.20
501 - Rental/Loss of Use $124.99
600-050 - Med Pay/PIP $
Other $
Salvage Recovery $
Amount State Farm Paid $4,902.19
Insured Deductible $250.00
Total Claim Amount $5,152.19
Based on the assessment of liability between the parties, State Farm Mutual Automobile
Insurance Company is seeking 100% of the Total Claim Amount listed above. The amount
payable to State Farm Mutual Automobile I nsurance Company for this loss is $5,152.19.
13-14M9-74G
Page 2
January 18, 2021
Please remit payment of this claim and include our claim number on the payment. If you have
any questions or need additional information, please call me at the number listed below. If I am
not available, any other member of my team may assist you. Thank you for your cooperation.
In order to assist you in evaluating and processing the subrogation claim we are asserting, we
may provide nonpublic personal information about our customer. We are sharing this
information to effect, administer, or enforce a transaction authorized by the consumer. However,
you are neither authorized nor permitted to: (1) use the customer information we provided for
any purpose other than to evaluate and process the subrogation claim, or (2) disclose or share
the customer information we provide for any purpose other than to evaluate and process the
subrogation claim.
Sincerely,
Stephanie Easterbrook
Claim Associate
(877) 787-8276 Ext. 6156927589
Fax: (866) 231-9276
State Farm Mutual Automobile Insurance Company
Enclosure
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