Smith �,r r National I]ocument Center
F.` � � � � � � P. O. Sox 2G8992
�klahoma City, C�K 7312G-8992
clairnsdocuments a7�pcs.com
Fax: 877-217-1389
Toll Fzee: S00-HelpPoint
02/13/2012
St.Paul Fire Dept RiskMgmt ����lyE�
Attn: Cliari Moore
15 Kellogg Blvd W Room 310 F�B 1 6 2012
Saint Paul,MN 55102
Our Claim#: 099 SUB 1018762201-1 �'��� �'LC�� �
Our Insured: Jolene Smith ,
InjuredPa�ty: AnthonyJefferson '
• ,..,....._.._,� .
our F e um er. . _ _- I�
Your Insured St.Paul Fire Department
Tota1 Darnages: $11,013.06
���'MEDICAL/PIP SUBROGATTONNOTTCE�'*�'
Dear Cliari Moore:
We have been informed that you are the liabilitycarrier for the above-captioned accident.
Our investigation shows thax your insured is responsible for our insured's bodilyinjuries
sustained as a result of this accident.
Illinois Farmers Insurance Company has paid$ 11,013.06 to date in Med Pay/PIP benefits on �
behalf of our insured We have a right of reimbursement for these expenses and request that
reimbuisement be sent directlyto us. No other partyhas the right to represent our interest
in this matter.
Attached is a medical ledger of payments tendered on behalf of the injured party. Please
submit payment promptly.
If you have any questions you may contact me at 425-430-2329.
I
Thank you for your attention to this matter.
Sincerely,
Illinois Farmers Insw�ance Company
�\
��_,2_„��.� �,j..�_��%�
Jo�J.Vegas
Medical Subrogation Representative
425-430-2329
joanna.vegas@ hpcs.com
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