MA FY 10/11-CL130214 FACSIMLE R CMR Claims Department
6 � " e Zcsk, �' JITY, OK 73146-0770
TO: City Of Coppell
Company:
4 /
Fax Number: 1 972 304 3570
Phone Number:
FROM: Renee Kinkade
Fax Number: 405-606-3177
Phone Number: 1-800-321-4158 EXT 8276
NOTES:
Date and time of transmission: Thursday, February 14, 2013 9:01:24 AM
Number of pages including this cover sheet: 02
Verkgrt Cut Drop Billing Form
C!aim !ntormation
Claim Number Employee Name
TXPR121977
Verizon Exchange RIM!Address
5647
Budget Center oac s ame
1TJE
Coach's Telephone Coach's Email Address
AIM= MEM=EI
Cut Droo Information
Name of Person or Contractor to Bill Date of Damage
PRABHAKAR MANI 2012-04-11 00;00:00
Address
933 BLUE JAY LN
City State and Zip Telephone#
COPPELL,TX 75019 x
Locate Requested? Locale Done?
N N
Locate Date Locale Rep Name
DdIIraye Sheet AddieSS Custurner Telephone 1!
933 BLUE JAY LN
City State and Zip Customer Name
COPPELL,TX 75019
Length of Cable . i er.
110 N
Municipal/Business/Residential Additional Work?
•N
Remarks
CX CUT DROP
BiIIinQ Information
v
Labor Hours Account
1 642340
Contractor Involved? Contractor Amount
Y 88
Contractor Explain
Other Information
PDRKEY V35457
Disp Ticket Num TXCP090C50
Comp Code 9TS
JURISSTATE TX
TAXEXEMPTIND
j File Date I 2012-05-21 DD:00:00
FACSIMLE
CMR Claims Department
ti R 812LES1ORVITY, OK 73146-0770
TO: City Of Coppell
Company:
Fax Number: 1 972 304 3570
Phone Number:
FROM: Renee Kinkade
Fax Number: 405-606-3177
Phone Number: 1-800-321-4158 EXT 8276
NOTES:
Date and time of transmission: Thursday, February 14, 2013 9:01:50 AM
Number of pages including this cover sheet: 02
veri n
BILLING STATEMENT
Billing Date: 05/23/2012
Bill Number: TX4V354570512
Mail Correspondence to: Bill Type: BSW
CMR Claims Department Work Order: 9TS 5647
PO Box 60553
Oklahoma City, OK 73146 Questions? Call: (800)321-4158
DESCRIPTION OF DAMAGE
TYPE OF FACILITY: DROP WIRE
LOCATION: 933 BLUE JAY LN
COPPELL, TX
Damage Claim Number: TXPR121977
Date of Damage/Discovery: 04/11/2012
Charge Description Hours Amount
VERIZON COST TO REPAIR $ 263.20
Total Amount Due Upon Receipt $ 263.20
Please write the bill number on your check. Mail bottom stub with your payment to address below.
Ir: the ever:= your cued, for catimient of your Ver_zun Conrnur_ cat_ona b_1- _a rent,=:red by your bait for -nsuff=cier:t or
I.i'Iroll-I ecrer; f..lyds, :l?"'znn may I"e.5-.i hm-Y your c'leek el er.t.-on,C.a•-ly to your h.ar-K for ipA.-man`. rrnm your f:her.kl no .aC.r.oi:nh_
Claim Number TXPR121977
veri h Bill Number TX4V354570512
Total Amount Due $ 263.20
SPECIAL PROJECTS BILLING Please Pay Upon Receipt
PRABHAKAR MANI
•
933 BLUE JAY LN Verizon c/o CMR Claims Dept
COPPELL, TX 75019 P.O. Box 60553
Oklahoma City, OK 73146
513TX4V354570512BSW2052320124000000000002632024