Claim by John & Dianne BrimeyerWESTFIELD
INSURANCE
A member of Wes~eld Groups""
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April 9, 2007
Gus Psihoyas
City of Dubuque
Sewage Dept.
925 Kerper
Dubuque IA 52001
Re: Insured: JEFFREY A BRIMEYER and DIANNE BRIMEYER
Claim No.: NR-WNP-1655975-032607-A
Date of Loss: March 26, 2007
Dear City of Dubuque:
Our insured has made a claim against an insurance policy with this company for
damages received as a result of a loss occurring on March 26, 2007. Our
investigation establishes that you are responsible for those damages.
We are legally entitled to recover any payments that we make to our insured as
a result of this accident. Any settlement of this claim by you or your
insurance company must recognize our right of subrogation as provided in the
policy with our insured.
If you are insured:
1. Send this letter to your insurance agent or insurance company.
2. Complete the enclosed form, and return it to us immediately.
If you are not insured:
1. Complete the enclosed form, and return it to us immediately.
2. Contact this office within five days to discuss how you will pay for these
damages.
Yours truly,
James M. McEntee
Claims Manager
Enclosure: Insurance Information Form (CD 321)
Self-addressed envelope
6005 Rockwell Drive N.E., Suite A
Cedar Rapids, IA 52402 1319) 393-1032 or 1-800-243-0239
FAX 1319) 393-4293 www.wesffieldgrp.com
CD 322 (Rev. 9-89)
. WESTFIELD
INSURANCE
A member of Westfield Group'
INSURANCE INFORMATION FORM
DATE:
Re: InSUred: JEFFREY A BRIMEYER dnd DIANNE BRIMEYER
Claim No.: NR-wNP-1655975-032607-A
Date of Loss: March 26, 2007
Claim Rep: James M. McEntee
The following information concerning my insurance is being furnished as
requested in your letter:
NAME OF MY INSURANCE COMPANY -
MY POLICY NUMBER -
NAMED INSURED ON POLICY -
NAME OF MY INSURANCE AGENT -
MY AGENT'S ADDRESS -
MY AGENT'S PHONE # -
SIGNED
[ ] CHECK BOX IF YOU ARE NOT INSURED
PHONE
6005 Rockwell Drive N.E., Suite A
Cedar Rapids, IA 52402 13191 393-1032 or 1-800-243-0239
FAX (319) 393-4293 www.westfieldgrp.com
® 321 (Rev. 1-90)