Barrett (3) ��������* � I�E C E I VE D Correspondence Only
P.O. Box 512929
�u� �3 ��'�� Los Angeles,CA 90051-0929
Phone:877-818-0139
06/10/2013 04:57:00 PM
C I TY C L E RK Fax:(888)781-6947
To: CITY CLERK OFFICE
Company: CITY OF ST PAUL
Our Insured: SCOTT BARRETT
Our Claim#: 133604804
Date of Loss: FEB O1 2013
Your Insured: PETER DAVIS
Your Claim/Policy#: C130044
Total Subrogation Balance: $7,753.54. This includes our insured's $500.00 deductible. We are seeking
reimbursement at 100%, for a total of$7,753.5�.
Please take this as formal notice of our subrogation rights with regards to the above captioned claim.
We have completed our investigation into the facts of the above captioned loss and find that your
insured was the proximate cause of the accident.
Please make draft payable to " as Subrogee of SCOTT BARRETT", and remit to:
Subrogation Payment Processing Center
24344 Network Place
Chicago, II 60673-1243.
If you need additional documents or information,please fax your requests to 888-792-5922.
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Thank you for givi this matter your immediate attention.We look forward to receiving your payment soon.
. / I
v
CHRISTOPHER W00 FOLK
Subrogation Department
Tel: 877-818-0139
PLEASE INCLUDE THE PROGRESSIVE CLAIM NUMBER ON ANY AND
ALL CORRESPONDENCE
June 10, 2013 , 16 :45 : 51
CMSD3330 /CMSM3330 P A C M A N JUN 10 13 - 16 :45
OPID: CXW0099 SUB FEATURE OP�N SELECTION TERMID: ?OM5
INSD: BARRETT, SCOTT � POL#: 900129334-3
DOL : FEB O1 13 NIlV-CR PCS-GRP-A CLM: 133604804 ACTIVE REP : J BUCHANAN
ADVRS PRTY: SAINT PAUL REGIONAL WATER SERVICE PH: -
SUB FEATURE LINE - LINE - FEA REP LOSS PAYMENT DEDUCT SUB
STAT OWNER COV COV DESC # ID TOTAL W/HELD SC*
-- ------------------- ---- -------- --- -------- ------------ ------------ ---
O BARRETT, SCOTT 2983 PIP MED 002 MJM0072 191 . 00 F
O BARRETT, SCOTT 2103 COLL 001 JMW0040 7, 062 . 54 500 . 00 F
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DC912747 ONLY PAGE *
COMNIAND: SUBSUM
June 10, 2013 , 16 :45 :40
CMSD2320 /CMSM2320 P A C M A N JUN 10 13 - 16 :45
OPID: CXW0099 CLAIM PAYM�NT HISTORY TERMID: ?OM5
INSD: BARRETT, SCOTT . � POL: 900129334-3
DOL : FEB O1 13 MN-CR PCS-GRP-A CLM: 133604804 ACTIVE REP: J BUCHANAN
SEL DR.AFT L/COV PAY TO TYPE* AMOUNT DATE CD*CLR
478420880 COLL SCOTT BARRETT,ONLY L 197 .26 JUN 09 13 I Y
477260172 COLL HERITAGE AUTO BODY AN L 552 . 53 FEB 24 13 I Y
477262453 COLL HERITAGE AUTO BODY, I L 517 .30 FEB 20 13 I Y
477101231 COLL SCOTT BARRETT AND ** L 5, 795 .45 FEB 24 13 I Y
324004994 PIP MED GROUP HEALTH PLAN L 191 . 00 MAR 18 13 I Y
DC912747 ONLY PAGE *
COMMAND: PAYINQ
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