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Barrett (2)
03/22/2413 14:3d FAH 440 603 7740 PROGRESSIVE CAS INS CO � SOURCE CORP �005/028 RECEIVED APR 08 2013 �����4 Paymenl Addne�ss Document Address CITY CLERK ��,"��;'2� ���8 c�s, Phone:1��819-0138 Fax:(8B8)781-6947 3/i 6�201310�9:00 AM Certified Mail 917�08 2133 3934 256i �684 Retum Reoeipt Requested CIT`l 4F S7 PAUL C�'T�(CL.�RK O�FICE 31Q CtTf HAI-L 15 WFS�'KELLOGG BLVD ST PAUL MN 55102 Your Glient: DAVIS, PETER . _ __ . Your Gla+m Number: UMChIOWN Our I�uced:BARRETT,SCOTT pur C1�im Number. y3-3G04804 Amount�ubject ta Reimbursemer�t:y.365•28 Amaurrt of inaured's Deductlble: 500.00 Please take this as formal���ti at on i1�to therfacts af the abave-captioned loss and find daim.We have oomp�eted 9 that your insured was the proximabe cause of the socident• lacatipn of loss:HWY 36 EASTBaUND pate and Time of l..oss 02-01-13 @ 1:30 PM � pescriptjon pf Lvss:Our name insured's 2009 Chevrdet Silverado was stopped at a red light at F-IVVY 36 EB.A 2001 Toyote�GamN wa�stopp�d be�ind our insured's vehic� hlnai�Paul Regional Water Senriae,2005 Ford F�50�Nc�nse plate#�93165a,was�pp 9 insured's vehide from behind.As our insure�l was wai��9 for the light�o The��of the� Ford F�50 was unable to slow da�rn and strudt t�+e 2A01 Toyota C�m�Y• P�r Da 1s, is the a�Rision pushed the Toyota CamrY►nto our i�sured's vehic1e. The driver, proxim�te cause of the aoadeM far fai�ing to ma�nta+n a safe distanoe and driver was inatterAive. Pl�se make your draft payable to ProgreBSive Preferred In�urance Ca as subrogee af " BARRETT,SC.OTT ^,in the amourit stated above and maN it to the attention af the undersi�nQdie ahead'fteen(15) aanvenienoe.All supportiin9 docume�action is endosed. l have datied my ti days. Y k Y� arrtici t , promprt attention to this m�ctter- �.� �/ Chn e� oolfoAc Subrogadon Representative �� �� Progressive P�erred i�urance Co YI/ � � Tel.877-818-0139 Ext 37$O6 I N' �� FBx.888-781-6947 t � � Emaii: Christopher Woolfdkf�pr+ogressive.dom Q, �S� '`� � � { bu 2 �%��i pU� o � 03/22I2413 14:29 FA� 440 603 7740 PROGRESSIVE CAS INS CO � SOURCE CORP f�002/028 i NaTICE o�cLA►Ill+t Fo�Vi to t�se city of Seint ran�,�esota eLtuAaa�a 9ra�e Sbeaue�03�that"...eve►y pe�saA...w+�o�r�i•�dM►,�nm atir��'�.�1�'a�ee ro bs prr�rd�o tlie An►Kr�a�'Af��M�1'�laD�'����arBqlPy ��wls�8�efb�P�� draaw�a�ca��S►'e�f a�i 11�e on�oM►rr�ao�pa�+� 1�re��ii�rm�i��bq►e�an4 Hl�t°���°�'�°1°�a�"d`qoa�o. Ii�m�e�+be d ��+��'°°�1�e.a. PM�e noae t�t roa,r�nei b�eora�et�a b�tde�O�e 10 d+e��"�'•'D p'�� �o �,a�d tre a�a��tl�a 1�eb�''°9�'�°i' Yoo••O raoara� .vr11t�ae�aw�ei�a�0°� ra�i�. 'ltia p'OOew sd tf�M�e°�b°�i�r noM1 rplh�'AVA� �e a��a.r d.im. 'i�ir rarm wu�k 6e d�ea,�e�p�oampktd• S�EIVD COMPLETED F�RM A1�iD O'1'I�ER DQ�p�� S�IOZ� 15 WF.S���'*���310 CTl'X HALL, ��f1'ts�iJ�-��s. �cd A1$�r7 '�(f�C F�t NitmE a,- t� _ MddtC�n�ial —Iiust NiumG (3o�o�ny or Hu�ness N� , Are You an I�nr�Cam� Yes/No If Yes,C'�Nnmbe� a �- Sa�eet��s �,,��� �� 3rabe�.'.� Tp Code�'`�'�� �p�,�t i—= C.e11 P�o�c�r--;�A'►�a°mB T�gb°°ne(�;--- Dab�af Accideat/]njmy or Da�e'bisco�rod Rime ��Pd° what vc�aried(5���d why you�are submittidg a c]uim.Ple�e iolEic�e�'h7'o°�'bD'W Y� Pk�s�+e��e►m dcCn1, mvo�rod md/oc�a �ble far yaar�• f�the[�tY of Siint �Y°�� P4ease�lc tbt boo�(es)�bat most c)oa�ly���on for�$�� �ng i tow boo p My vehdo�va6 d�n�jed yehicle was da�+a�d��acadCat ��o��� was � o�w ac �y�c1e a8���e+d bY Pol�Ok p j�iyr�s mj�'ed on�p'�p�Y p My vehicla wai wra�dlY towad sandlor�d C]Qd�r typ�af P�Y�—p�aP°af7 D Othet t1+pa qf in]�'—P�dP°�Y In orclet�o ptooess yo�ur c1� p�aee t�ame bo inclade tbe doc�i�ic�d oT it w�l de1�y tbe�g� yo�c,laim. Ao�����baco�tl�pro�d�ti'o�tbe City. Yoo m���� +,oPy�"r'y�r�if br�o�e sub�m�t�g yo���°- �y .rbic�if ine��oeeda 0 prupercy�e�ta s vel�la two a�s fa�e�repa�s Yoar $SOOAO:ar tbt aad�l b�k a�ndfar ieoaPts fo��� O Townag d�m�4:leg�bk c�e�°��]'��sued amd a capy af 1be�aapaoad]�t s'e�e�Pt a U�er pr+op�atY�G�:two r�p�ea��the d�$e�5900'00�.�tbe�ud b�ls st�lJor rtooiDls far t�e�ep�:dt�led�et aF dm�ag�ed�r�s p Ipj�cy ct�w�oc m�edic�l b�ls,teoeip����nd aupport Yonr cl�um but�not be e�. p p�y,�pha ne al�ways welco�ne �e 1 ot Z—Aare�ompktc�rt�a�oth�ges d�Foe� 03/22/2Q13 14:29 FAK 440 603 7740 PRO�RESSIUE CAS INS CO � SOURCE CORP �003f028 pescription of l�ss:Our name insured's 2008 Chevro�et S���e�ado was s�opped at a��d light at HWY 36�B.A 2001 Toyota CamrY Was�t°PG'ed behind t�ur Insurecl'�vehicte•A Satrrt Paul Re�ior�al Water Servioe�2009 �d F25Q,Iloense plate#93165Q,�apl��ing our insured's vehide from behind.As our insured was w��bng f0r����9M t°tum g�'m�� Ford F250 was unable�o slaw down and sttud<the�001 Yoyota Camry.T1�e impact of the collision pushed the Toyata Gamry ir�to aur insured's vehicle.The driver, Pet+er Davis, �the proximate cause af the acadent for fai�r�g ta rnaintain a safe distance and driver was inatte�bve. 'i i 03/22/2013 14:29 FAH 440 603 7T40 PROGRESSIUE CAS INS C� � SOURCE CORP f�004/028 l�ne�e bo c�i��d remrn botlt p■�ea w�radt in d�q�the b�C���°°�' � TJnlon�aa (�1�) Were the�e Nimes*es tio tbe incideat? Yes Pro�viCc ehe�mmos.addre�as and t�Cpho�c�usnbs�: Wtre tbe po]i�aC or]Aw ea�t'� � � f� � }p y��,p}��t oc a�OC�+? q Y�s � Caee#or�tpo�t ? Fno�ido sl�eat sddneei.�sMOe��►�'�P�`or f�ity, Wbae d�d tbe�t��1��� � ��agary.a�s� C�psest � �c �ut yoo aouki h'tae tl�C(�i�►►to d0 m resolv�e t�c�im Pfe�iod�ate tl�amount�sie�� .,�• G tfl your�abi�C.�lioo. � Ycqu Vabic1e: Yeax M� �0� Ixmee P�ate N ��---� R�e�i�te�ed DriMer o�V�cic "'� r c�,r v�a�: Y� � �P�ls�e NumbOr sr�a�Calar Uri�er ad Vdsicb(C�ty F�nploYee*a Na�oe) Artut Da��d ❑ � Haw we�t Yoa injai'°d? �Vb�►t�b(s)o�Yaw b°dy wa+e m,jntid? �e�u wu�t n+eaical� Yes No P�S ip Sak Tn�eat(��id�dabo(s)) VVben�id yo�a rooeive�t? Name o�I�te�icx�1 Avvida(6): '�� A y� Tia Did ycyo miss wo��s a reaalt of yo�w'ifl1� (pzo�vide dsoeta)) Wl�n did pou tn'ssi woel�? Nanna oi yo�r Ea+pl�a: Te�1a�e Add�se p G�ac��e ii?on�e d't�r]��p��to�ela�lorm� N�ber a[�[tla�l P� • �+�B�f°�!�an im�8���"�`�►a e mrd corntct b ffiu� of�r iaro�wJa�e. iT�+sg�dlar�+s u'+�Mot be p�s+r� � �� � Sab�B a���E1�resw�t iK p�+ossa+Jio�r. D�e�orm was oampl�ted Pci�t t�e N�e dthe P+e�reon wbo � . l� '4�bD gi�b�e af Pe�on Maldag t� Rsvi.ea Fdunur9�i11 03/25/2413 1Q:�1 FAx 6�14682641 PROGRESSIUE f�001/003 ��4�������� Date .�jl�r�.'']Time � t '��,� . To �L,,,,L� w`Iq _ Fax #� `-'�� � ��, � �Q`'ti(�'� Addre�/Bax � PhonelNetworlc � �ram ����G Fax��J l'_ L� ,� � Addr.ess/aox# ' _ _ _ _ PhonelNetwork � �.�� 2��_• ��� #' of Pa�es Transm�'tked � , PAessaqe � • �7��I5 nn.��— � c�u� ��- +� � � � � � � ���� �� � ��. f . � . a p rogressive.COm � � a o' AUTO • MOTORCYCL � - ATV • $ OAS � P1NC - RV • COMMEItGtAL AUTa 03/25/2013 14:51 FAX 6514682641 PROGRESSIUE f�002/003 �.. ..� ,�.,. .r r... , ._.,.— r �������� D55B705 - 1908 ��� t�r �r�s� �'•'' � DLIPLICATE � • 274� MAIN ST NW S7'E 1�2 asctlptlon Rata A�nount - K � CpON RAPIDS MN 55448-t273 17 OAYS � 37.99 645.68 '"r MNR�GFEE 32-2g fi�'�5i' 40-04 ,,: MNRENTL ; , �� SALES TAR7 7.12 46.�2 'I BI II To: �� "n'" .wa�»w�wiaooa.,.��oaiwre �r�. ����� SCOTT BARRETT 6467 PHEASANT H1LLS ORIVE LINO LAKES MN 55038 . �,' , ���^,4�� � t����.��i �•.��i i�1.�r �l��;�i� D�ts Qut Dst� In , . . __ . . -r '' 2/45/13 2/21/18 �ci�`��`` t'f� ROf1f9� ,;,,,y��.� SCOTT BARR�YY OTAL CHARGES 764.19 AddilfonslDmrer E95 AMOUNT RECEIVEO 764.18 Name NONE AMOUNT DIl�...... .. . .. . . . ` .o � � � Colar I.icen�e 1�• Cl�im !�/Poli�y NtP.O. # ���{�q �nqulrlee Call Fed Tax ID M � SILVER '192,1CY 138604804 �F$-329-1134 28-4548555 � Madel I.Init 1P Insurad — 12 8150 7G�MK5 BARRET7 SCOTT D.ate of �oss Type.o.f La�s •• -••• �• ' 2l01/78 INSUR�D Type of Car Ropsi� Skop b�";�'t'i�, �r�!�! �y,:r� i��tir�F�:i,�lrS„t' �:i?M1�I'�;"'iss�. CHEVROLET HERITAGE AUT DUPLICATE COPY P�EASE CISREQARD IF ALREADY PAID � ■ ■ ■ ■ ■ � A ■ • ■ ■ � � ■ ■ ■ ■ � ■ t ■ ■ ! ■ ■ f ■ ■ ■ Please Return This Portfon wfM Remlltar►ce� AINOUNT DUE. ..•. ••. . .• . . • � .Ofl Remlt to: Pald by: FNTERPRISE LEASING COMPANY gCpTT 6ARRETT ATTfV: ACCTS RECEIYABLE 8487 PHEASANT HILLS DRIVE 2775 BLUB WA'T'ERS flD LINO lAKES MN 95038 EAGAN MPI 55121-1439 � 9gg999�� 05 6y05�aamant Amou D0 0 9 i�, Gis 02/25 03/25/2413 10:51 FAx 6514682641 PR06RESSIVE I�003/003 H6p17AG! puYa BuUY fNC b78 COON RpPrU3 60Ul�VAkU COON ARPrG6, MN d549y 1'f637 7Bi-7�3q , $aIg Me�chant ID� �42929984�3�44$ 1e�W ID: 1K9451�3 k. 82�21�13 xq;4T:6B But<hu: BiA278 Tnv Y; 88�188y dIS� Entrv �ethod; S XKXX%XXXXKXX6112 Se�,N; 6883 gppr Coda, @81385 Tot�l � � 500, �0 � ARPROV�b Cuako.rr CePr 7hANK Y0111