Claim Feldman-Brauer by Secura Ins.
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June 29, 2005
SECUM
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2401 S. Memorial Drive
P.O. Box 819
Appleton, WI 54912
(920) 739-3161
JEANNE SCHNEIDER
CITY CLERK
50 W 13TH ST
DUBUQUE IA 52001
RE: Claim:
Insured:
Date of Loss:
P18775
YOLANDA FELDMAN-BRAUER I 1314 A +Ia",-+ Ie" Sf
6-05-2005[) U bu ~ue "J A-
Dear Sir/Madam:
Enclosed please find our notice of claim and itemized statement of claim. Weare
making a claim against THE CITY OF DUBUQUE IA for $550.00 due to damage to
sidewalk caused by an employee of the City of Dubuque while removing a tree.
Please notify us in the event the claim is disallowed.
~CerelY, n..
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Patti Rutzinski
Subrogation Representative
920.739.3161 Ext 4469
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NOTICE OF CLAIM
Please be advised the SECURA Insurance Company hereby makes claim against you in
the amount of $550.00 for damage to sidewalk. This company's insured property, owned by
Y olanrla Feldman-Brauer, was damaged by the negligence of the City of Dubuque IA
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employees. .:> !)Ll.",ut"e ~~
SECURA Insurance has coverage on the property in questions which affords subrogated
rights
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State of Wisconsin
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Outagamie County
Patti Rutzinski, being first duly sworn, certifies that she is a Subrogation Representative
employed by SECURA Insurance Company, that she has read the foregoing Notice of Claim,
and that the information contained in the foregoing notice of claim is true and correct.
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1S involving extra costs will be
ne an extra charge over and
In strikes, accidents, or delays
Respectfully
tl.uateol Accapt~
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the work as specified.
Signature
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