ST9302-CL010813DISTRIBUTION LIST: C.....-/
Jim Witt, City Manager
Bob Hager, City Attorney
Vivyon Bowman, Director of HR
Texas Municipal League
Lawsuit File (original/copy)
COMMENTS:
\\TWN_CTR\USERS\Kwilkers\Claim Forms\Suit Transmittal Form.doc
Kevised 8/19/94
Aug-13-O1 07:07A Kwik Kar' Lube & Tuna 940/381-9838 P.O1
~ ~e/ (For Officc Usc Only)
CLAIM NOTICE t~xgt/~ CLAIM NO. 0 ~ 10 ~oo/-[ FII.EI) IN
~ ~ MY OFFICE THIS 'I'IlE IO~ DAY OF
DEPU~ CITY
Ciw Se~etau
City of Coppe~ (972) 304-3673 (FAX)
P.O. Box 478
CoppeII, TX 75019
This is my notice of claim against the Ciw of CoppeB. The cffcumstances giving rise to this claim
are as follows:
approximately q :_'~0 o dock PM , at the spec~c location of ~
}~tc~o~ M ~{~ l~ ~.~ d~ , i.-boppelI, Texas.
2. The damage or inju~ occurred m the fo~owMg manner:
3. extent of~y damages and/or injuries are as follows ~e specific - attach estimates,
bills, etc. if available):
4. The amount ofdamages claimed is $ W~I~ [T~,OxZtO. g) d5~~-,% __
(Ple~e Print)
Claimant ~q DUa0¢~L% Phone O~.L..) .'50~ '- ~l~ 7 _
Ama Code
Address 10lq (~fi2~ Ct~SOlfl~ Ci~/State/Zip doDO~l ,~ ~_. W~q
(Also list previous address if I~s than 6 months) r ~
I do swear the above is ~ue and co~ect.
Thc not~chtion shall bc fitcd within six (6) months~e date of injury or damage or, in the case of' ~eath, within s~ (6) months
tl~e date ol'death. The t~ilure tt~ ~t~ C~ with~ thc time and manner specified shall t'xoncratc, excuse ami exempt thc City
fi'om any liabilily whatsoever. (A~icle 11, Section 11.09 o[' ~hc Home RuLe Cha~er - Damage Suits)
940 581 9858
Aug- 13-01 07: 07A Kwik Kay"- Lube & Tune 940/381 -9838 P. 02
~~ ~ /~" JOHN ROBERTS BMW ~-
~ FOREST ~NE AT O~ON OR~E · D~$, T~S 752~ · (9~) 247-7Z14
................. ~ ~ ~ ....
TU O~RAT[~ PA~T NO ~AR TS ' '~BO~
~.~ ~/~_~ ~_~ ........... ~,,
~ '
.....~ ~ ~
-~ ~ d '_~'/~ _ ~o u ~ ......
Si INS CO. PAYS R.O NO. TOTALS ~ ~ .....
~S. CHECK PAY~E TO WRECKER/ ~ ~
~ ~i~ w~h ~ ~t e~U~l o~ ~ h~i~. O~ations on ~ ~ ~r ~e cu~ a~ su~ to
· o~A~ OF
ESTIBATE
~40 ~E]i
Aug-13-O1 07:07A Kwik Kar Lube & Tune 940/381-9838 P.03
~~~~ JOHN ROBERTS BMW
O T ~NE ~T DENTON DR~ · DALLAS, T~ 7SZ~ (9~) ~7-7214
~ U OPE~ON8 PA~T NO ~TS
E~ ~OE BY
AuQ- 13-01 07: OBA Kwik Kar Lube & Tune 940/381 -9838 P. 04
~UU1-U~- llJ l '1 :~*~ r
E~ma~ Ve~ion;
CONCOUR$ PAiN¥ & eDDY, IN(;.
11415 A/tah~im Dr. Dallas, TX 75229
(9~21247-4700
Pax: (972) 4M-13~3
Damage Assessed By: Miff Center
Deciuctible: UNKNOWN
Customer: FR~ANK OUDOIN1CZ
Line Entry Labor Line ~ Part TyI~J De,ar Labor
I~em Number Tylae Ol~aralion I~e~rlption Part Number Am~aunt
:~"-- AUTO BOY OVEI~AUL I;I;L1 C;'d~/ER ASSY ---- (].IS
2 401168 BDY R£MOVF-jR~ePi~KCE FIRTBUMPGRCOVER 5~ 'ti 8 ~66 143 214.00 lNG
:) AUTO R£F REFINISH FRT BUMPER COVER C 2.3
4 40'11~i9 BOY REMOYt:/R~PLACE FRT I~UMPER MOUNTING PRO 51 1t 9 0S9 4,61 15.10 INC
6 402120 REt BLEND 14000 OUTSIDE C 1.1
$ 402920 BDY REMOVEJIN$'rALL HOD0 EMBLEM E:delJr, g 0.2'
7 401428 BOY KEMOVI:/REPLACE R FENDER PANEL 4~ 35 8 122 236 287.00
8 AUTO REF REFII~lSH R FENDER EDGE 0.5
9 AUTO REF REFINISH R FENDER OUTSIDE C 2.2
l0 41'/'8~0 BDY KL=M O'~EIIN~'ALL R W/~H~LO WASHER NOZ:ZLE E. zietin g
'iX 417860 BOY REMC)VI;II~IgTALL L WP3HIELD WASHER NOZZLE Exia'Ung 0.3-#
12 42'~010 REF BLEND R FRT DOOR OUTSIDE C 1.0
13 403107 BDY REMOVE/INSTALL R FRT DOOR MIRROR
14 42'r3]'4 BDY REMOVF. JINb-rALA. R FRT DOOR MLDG 0.3
15 400~O3 ;IOY REMOVE/INSTALL R KRT DOOR TR~M PANEL
1~ ~00~ BDY i~'MOVE/]NSTJ, LL R PRT O~'~ II'OR H~NDU~ '1.4
17 40025~ ~DY I~PAIR R RO~K~;R OUT[;R PANEL -S Exi~in9
11 AUTO I~_F R~FINISH R ~.OCK~R PANEL C
']9 936012 A~D'L CO~T HAZA~U$ WASTE DISPO3~.L 5.00 '
20 ' AUTO REF ADD'L aPR CLEAR COAT ~.0
21 g3300~ ~DY ADD'L aPR UND~;RGOAT/NO 10.00 '
22 ~33008 ~ F ADO'I. ~JPR C, HIP RESISTANT MATERIAL APPLICATION 10.00
23 933017' KEF AI~D'L aPR COLO~ ~NtO & BUFF 10.O0
Z4 933018 REF ADD'LOPR MASKPOROVER8PRA¥
25 AUTO ADD'L COST PAINT/MATERIALS 260.00
' - Judgement Item
# - Laber Note Applies
C - Included ~n Clear Coat Calc
ESTIMATE RECALL NUMBER: 8/8r2001 14:19:S2 4846
UltraMt~, i~ a Trademark Of MIt¢llel! tmernatlonal
Mit¢~ll Data Version1: JUL_O~A Copyright lC) ¶~94. 2004) Mil'ah~ll International PaOe 1 of 2
UltraMata ¥eralon; 4.7.007 All RioIlt8 R~q~V~I:;I
Aug- 13-01 07: 0SA Kwik Kar Lube & Tune 940/381-9838 P. 05
· ' ~UU1-U~-IU 11 .*&~ r ~'/~
--: Date:
Es~ma~ iD;
Profile ID: CUSTOM~D
~ 8ub~
I. La~r Subt~al~ Uni~ ~ Am~nt ~nt TQ~ Il, P~ ~a~nt ~umma~ ~ou~t
Nofl-T~able Labor 1,~0.~ T~al ~pla~ent Parts Amount 537 03
Lair ~umma~ 27,9 1,~
IlL AddiUon~ ~=~ ~ou~ IV- ~J~tmen~ Amount
Taxab~ C~ Z~.~ C~m~ ~DOneibility
SMOs T~ ~ 8~ ZI.~
Nofl-Ta~ble C~q~
TO~I A~dltlonll Cos~
II. TMul R~l~men~ ~: 537.03
~. To~I A~; O.0O
~ is a preltm~ estimate.
~nal chan.~ ~ me ~tlmate may be mOHiF~_f~[_the ~c~ua! re._ir.
ESTIMATE RECALL NUMBER: 8] a~2001 14:19:52 4~46
UltraMate is a T~a~ Of Mitchell I~emational
M~chell D~ Vereion: JUL_01_A Ga~right (C) t~ - 2~0 M~che[t Jn~rnMionaJ Page
Augustl5,2001
Ms. Nancy Johnson
C/o Ed Bell Construction Company
P.O. Box 540787
Dallas, TX 75354-0787
Dear Ms. Johnson:
Enclosed please find a claim for Leah Dudowicz.
If you have any questions, please don't hesitate to contact me directly at 972-304-3635.
Sincerely,
Vivy'6n V. Bowman
Director of Administration/HR
cc: Ken Griffin, City Engineer
Clay Phillips, Deputy City Manager
Leah Dudowicz
VVB/td
265 PARKWAY ~ P O BOX 478 ~' COi~PELL TX 7SOl~J ~, TEL 972462 0022 ~' FAX 972/304 3673
T H E C I T Y 0 F
August 15,2001
Ms. Leah Dudowicz
1014 Gibbs Crossing
Coppell, TX 75019
Dear Ms. Dudowicz:
This letter is to notify you that your claim against the City has been forwarded to the
insurance company of the contractor working on road construction in the area at the time
of your accident. Therefore, the contractor is responsible for the claim.
The name of the insurance company is: Ed Bell Construction
P.O. Box 540787
Dallas, TX 75354-0787
The name of the contact person is: Nancy Johnson
Her telephone number is: 214-358-6581
Please contact Nancy with any comments/concerns regarding your claim.
Sincerely,
Vivy'on V. Bowman
Director of Administration/HR
cc: Nancy Johnson
Ken Griffin, City Engineer
Jim Witt, City Manager
Clay Phillips, Deputy City Manager