SAFEWAY INSURANCE COMPANY

ARIZONA
P.O. Box 22078 ● Tempe, Arizona 85285-2078
Claims: (480) 730-0026 ● Claims Fax: (480) 491-6219

November 22, 2021

Peterson Begay
Hc 58 Box 70 Unit 104
Ganado, AZ 86505

RE: Insured: Peterson Begay

Policy No.: 3074850-AZ-PP-003
Claim No.: 1115326-AZ-PPCL
Date of Loss: April 16, 2020
Claimant(s): Tisha Curtiss

Dear Peterson Begay:

This letter is in regards to the claim presented against you and Safeway Insurance Company for
damages incurred by Tisha Curtiss arising out of an accident which occurred on April 16, 2020.
The purpose of this letter is to advise you that a demand has been received from Lerner and
Rowe, PC.

Lerner and Rowe, PC is demanding $25,000.00 to settle their client's claim. For your review, I
have attached a copy of the demand letter(s). We ask you to review the enclosed demand letter in
its entirety and pay particular attention to any due dates imposed and express terms or conditions
which may require action on your part.

Please review, complete and promptly return the enclosed affidavit prior to any due date. The
completed and signed affidavit is a required condition of this settlement demand and therefore
necessary to achieve a personal injury settlement. Your cooperation in this regard will aid our
efforts to quickly resolve the claim being made against you. Should you have any questions or
concerns about this request, please feel free to contact the undersigned. The affidavit must be
notarized.

Your policy with Safeway Insurance Company affords a Bodily Injury Liability policy limit of up
to $25,000.00 per person, not to exceed $50,000.00 per accident to settle injury claims for which
you are liable.

Please contact us to advise if you have any other available insurance coverage that is or may be
available to you in order to advise that or those insurance carriers of the claim being made against
you. Should the above listed settlement demand(s) exceed the amount of your bodily injury policy
limit please contact us to advise if you are currently able to contribute any additional money
toward the settlement.

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Be advised, you have the right to retain an attorney of your choosing and at your expense to
represent your interests concerning the excess exposure you may face in this matter. It is not our
intention to convey to you the thought that it is necessary for you to retain counsel, but rather that
it is your right to do so, if you desire.

Should you receive any legal paperwork in writing, you must contact us immediately so we can
hire an attorney to file a timely response on your behalf. If you have any questions, please contact
the undersigned at (480) 730-0026, extension 5174 to discuss.

Safeway Insurance Company will continue its efforts to resolve this matter within the limit of
coverage available to you under your policy of insurance in exchange for a full release of liability
for the claim being made against you, as referenced above. If you or your attorney have any
questions or concerns regarding this letter or the claim, please contact the undersigned at your
earliest convenience.

Sincerely,

Rosario Derbyshire
for Justin Blechman
Adjuster
Safeway Insurance Company
Extension: 5174

All email communications must be directed to AZclaims@safewayins.com. Please refrain from

communicating through personal Safeway email accounts. Be sure to include your claim number
in the subject line of any electronic communication.

19.11.2502.0
 Claim Number: 1115326-AZ-PPCL

AFFIDAVIT OF INSURANCE

I, Peterson Begay, having been first duly sworn do hereby state as follows:

1. I was the driver and registered owner of a 2004 Chevrolet Colorado/Ls which was involved in an
accident on April 16, 2020. With regard to this accident, there was no insurance policy in effect
providing any coverage on said automobile except as follows:

Carrier Policy Number Liability Limits

Safeway Insurance 3074850-AZ-PP-003 25/50/25
____________________ ____________ _____________
____________________ ____________ _____________

2. On the date stated above, the following automobiles were owned by me or members of my household:

Year/Make/Model VIN Owner Insurance Co. /Policy No. No

Insurance
_______________ ________________ _________________ _______________________
_______________ ________________ _________________ _______________________
_______________ ________________ _________________ _______________________

3. I verify, under oath and under penalty of perjury, that I have read and completed this Affidavit of
Insurance and that all of the above information is true and correct.

Dated this ______________ day of _____________, _____________.

______________________________________________
Peterson Begay

SUBSCRIBED AND SWORN to before me this ________ day of ___________________, ____________,

by Peterson Begay

________________________________________
Notary Public

My Commission Expires: ________________________

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 Claim Number: 1115326-AZ-PPCL

AFFIDAVIT OF ASSETS

I, Peterson Begay, being first duly sworn upon oath, deposes and says:
1. That I was the driver and registered owner of a vehicle in a motor vehicle accident on or about
April 16, 2020.
2. That I do not own any property other than items exempt from collection.
3. The assets that I do own have the following stated values:
a. Real property: __________________________________
b. Stocks, bonds, other securities: __________________________________
c. Whole life or universal life policies: __________________________________
d. Cash or other liquid assets: __________________________________
e. Collections (coins, jewelry, artwork etc.) __________________________________
f. Retirement plans including 401Ks __________________________________
g. Vehicles __________________________________
h. Other assets __________________________________
4. That at the time of the accident the vehicle was not being used as a work vehicle within the course
and scope of my employment or the driver’s employment.
5. I verify, under oath and under penalty of perjury, that I have read and completed this Affidavit of
Assets and that all of the above information is true and correct.

Dated this ______________ day of _____________, _____________.

_________________________________________
Peterson Begay

SUBSCRIBED AND SWORN to before me this ________ day of ___________________,

______________, by Peterson Begay

________________________________________
Notary Public

My Commission Expires: ________________________

19.11.2502.0