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2005-03-15 LMC Claim AcknowledgmentM league of Minnesota Cities Cities promoting exce~~ence League of Minnesota Cities Claims Department 145 University Avenue West, St. Paul, MN 55103-2044 (651) 281-1200 • (800) 925-1122 Fax: (651) 281-1297 • TDD: (651) 281-1290 www.l m n c.org ACKNOWLEDGMENT OF CLAIM ALBERTVILLE, CITY OF P.0. BOX 9 ALBERTVILLE Date: 3/15/05 RE: Our File No.: LMCIT Member: Claimant Name: Occurrence/Loss Date: Claim Description: Supervisor: Phone No.: Fax No.: Adjuster: Phone No.: Fax No.: MN 55301 11051632 ALBERTVILLE, CITY OF KERRY & JAN EVERMANN 3/08/05 SEWER BACKUP CURTIS HEITSCHMIDT (651)281-1284 (651)281-1297 JEFF HILL (320)259-9766 (320)253-0725 We have received this claim at the LMCIT claims office. The assigned claims supervisor and adjuster are listed above. The adjuster is your key contact on this claim. If you have not already been contacted by an adjuster, please call the listed phone number aid ask for the specific adjuster assigned to this claim. The claims supervisor is also available to you at any time. LMCIT Claims Department C.C. MIDDLETON & ASSOCIATES INC DBA MIDDLETON INSURANCE AGENCY 106 CENTRAL AVE E ST MICHAEL MN 55376 AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER