ACORD AUTOMOBILE LOSS NOTICE 9/14/1997 7:20:00 PM
Phone:     NAIC Code: Miscellaneous Info (Site & Location code)
Producer:   Oswego Mutual Company:    Oswego Mutual
Claim Number
714-465859-37AA		 Policy Number
01PA023011625-088 		Reference Number
 CAT #
Code: Sub Code: Effective Date Expiration Date Date of Accident and Time:
9/14/1997 04:37:00 PM
Agency Customer ID: Previously Reported: No
INSURED CONTACT
X
Contact Insured
Name and Address
Vecchio, Raymond
2926 N Octavia Ave
Chicago, IL 60607   		SSN
  		Name and Address
Vecchio, Raymond
2926 N Octavia Ave
Chicago, IL 60607   		Where to Contact
work or cell phone
Residence Phone
(708) 555-8599   		Business Phone
  		Residence Phone
(708)555-8599   		Business Phone
(312) 555-7298 or (312) 555-7295 (Cell) 		When to Contact
anytime 
LOSS
Location of Accident (including city & state)
S Lakeshore Dr, Chicago, IL 60616, Cook  		Authority Contacted:  Chicago PD  Violations/Citations
 
Report #:  not ready yet 
Description of Accident
IV, which was on fire, purposely driven into Lake Michigan. Insured claims car was rigged to catch fire by performance arsonist and the only way he could avoid endangering others was to drive car into lake. Damaged shipping container full of claimant's merchandise.  
POLICY INFORMATION
Bodily Injury
(per person)
 100,000

Bodily Injury
(per accident)
300,000

Property Damage
 100,000

Single Limit

Medical Payment
N/A

OTC Deductible
100

Other Coverage & Deductibles
(UM, no-fault, towing, etc.)
UM 100,000/300,000
TOW 75
PIP 20,000/20,000

Loss Payee

Collision Ded
 500

Umbrella Excess   Umbrella   Excess Carrier: Limits                 Aggr                 per Claim/OCC                         SIR/Ded
INSURED VEHICLE
Veh #
1		 Year
1971		 Make: Buick Body Type: 2 door

Plate Number
LCV 705

State
IL
Model: Riviera VIN: CCL447J127586
Owner's Name & Address
Vecchio, Raymond 2926 N Octavia Ave, Chicago, IL 60606 		Residence Phone: (708) 555-8599
Business Phone: (312) 555-7298
Driver's Name & Address
Vecchio, Raymond 2926 N Octavia Ave, Chicago, IL 60606 		Residence Phone: (708) 555-8599
Business Phone: (312) 555-7298
Relation to Insured
Named Insured		 Date of Birth
 Driver's License No.
V4258824547003 		State
IL		 Purpose of use
 Used w/ permission?
Yes
Describe Damage
Hood gone, entire car submerged in lake.

Est Amt
possible total loss

Where can veh be seen?
Police salvage yard, once car is recovered from bottom of lake. 		When can veh be seen?
unknown		 Other ins on veh
Driver Relation   Named Insured Vehicle Damage Severity   Possible Total
PROPERTY DAMAGED

Describe Property
Shipping container full of rubber duckies

Other Veh/Prop Ins?
Yes		 Company or Agency Name: Alliance All State Mutual
Policy #: CMP-983220-908-111-G4KR-A32-8
Owner's Name & Address
Xiong Imports, 1422 N Hooker St, Chicago, IL 60622 		Residence Phone: 
Business Phone: (224) 555-3825
Other Driver's Name & Address
N/A 		Residence Phone: 
Business Phone: 

Describe Damage
Shipping container of ducks split open. Damage to contents and some of contents missing or in lake

Est Amt
$17,088.37
Where can damage be seen?
Contact Marvin Xiong
INJURED
Name & Address Phone Pedest InsVeh OthVeh Age Extent of Injury
             
WITNESS or PASSENGERS
Name & Address Phone InsVeh OthVeh Other
Constable Benton Fraser, RCMP - Canadian Consulate, Chicago, IL (312) 226-2321 X    

Remarks:  Insured stated that there is also a claim on his homeowner's policy for a fire started by the same arsonist - Greta Garbo. Contact insured for further information about this party. He is a police detective and his department is handling the case against her. Insured thinks it's possible that when hood flew off it may have hit a parked car - IL plate RCW 139 but isn't sure. Hasn't been able to reach owner. Insured says best place to reach passenger is at insd's work number, rather than number given above due to difficulty adjuster will have getting past receptionist.
Reported By
Insured 		Reported To
Dottie Duer		 Signature of Insured
 		 Signature of Producer
Reporting Solutions, Inc.
ACORD 2 (4/30/96) QA Review
X
RSI 1996
 
  Extra Info 9/14/1997 7:20:00 PM
Phone:     NAIC Code: Miscellaneous Info (Site & Location code)
Producer:
Oswego Mutual 		Company:
Oswego Mutual
Claim Number 714-465859-37AA
 Policy Number
01PA023011625-088 		Reference Number
 CAT #
Cause Code:
Single Vehicle		 Effective Date Expiration Date Date of Accident and Time:
9/14/1997 04:37:00 PM
Reported By Code: Insured Previously Reported: No
PROPERTY DAMAGED
Property Damage Severity
Heavy