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ST9302-CL010828 LAWSUIT/CLAIMS AGAINST THE CITY TRANSMITTAL FORM DATE" C~-~2, ~- aO0 / CLAIMANT/PLAINTIFF: ,._'7Y'19c,.~ .~/~ ¢ ~'~; ~ c,.~, DISTRIBUTION LIST: t// 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 Revised 8/19/94 9?23942358 AUG-2?-2001 09:21 FROM:TRINITY 5TH FLR 9?23942558 T0:972 504 5675 P.002/002 C~AIM NOTIC~E. (For Office Use Only) ~ f~X~.~ &d CLAI1vI NO. 0 g,~ ~g e~O0t, I'~ F~ED~ MY.O~CE TInS ~ ~ ~nV OF ~.,~ ..... 20~ I -31-0 / '" Ci~ of CoppeH (972) 30~3673 ~) P.O. Box 478 CoppeH, TX 75019 ~ ~ my notice oFcla~ aga~st ~e Ci~ oFCoppeH. The c~mstances giv~g r~e to ~is claim 20~ appro~atel~ ~, VS ~ ~o~_ _~ , at ~e specie ~ation oF ~D.~ / 2, ~e ~mage or ~ju~ oc~eH ~ ~e FoHo~g ma~er: 3, ~~ ~- ~~ ~ ' ~~~~ ~ ' 'mates ~~'t of my damages and/or ~jufies are as fo~ows Oe~a~--es~ b~s, etc. ~avaflable): 4. The amount of damages claimed is $ ( (Please Print) Ctaimant (~O g ~3 (~off~-OIgA/L] Phone(,qTa)'..~Oq-g-/3 Area Code AddressC~c98~.~_m~0el ~L-U/'~ Z.-~9... City/State/ZipOO?P~ }J ~ ?,.fi'b/? (Also list previous address if less than 6 months) I do swear the above is true and correct. The notinc~o% shah be filed within six (6) rnonth~t~ date of injury or damage or, in the case of death, within six (6) months o the date of e~h. The failure to SO notify the City ~.m.)the time and manner specificd shall exonerate, excuse and exempt the City from any liability whatsoever. (Article I I, Section 11.09 of the Home Rulc Cha~ter - Damage Suits) Revised ! 1/00 COPPELL POLICE DEPARTMENT [ ]Offense Investigation [Sd Information Report Incident # ~/- t..//¥/'~ Date/Time Reviewed: o~t a.a.,~ Date ofReport: O~'~D- 'OI Time of Report: 1<~/33 hrs. Related Incident # L3/- ~/q/Od,, Locationoflncident: ¢O© '~>k~ o¥ ~. ~x,,~ L~lqe County: ~3,,Ala~ city:Coppell Earliest Date & Time Occurred: O~'-.:~-O t / a)0~$ hrs. Latest Date & Time Occurred: O~-oZ,~-o! /9/o hrs. Offense/Call Type:. ~N~¢o¥ ~-~ C'c,-~ Icc t CtO, a_~ Statute: Brief Summary: ~?c-~*~x-~ ~,3cc,o,:k-c~AL-{~c> _~EO-lq ~x.b~°c% ~ Property T,vpe Loss: Qty.: __ Property Code: Brand: Serial/OAN: Description (size,color,style,condition): Value: $ NCIC# Type Loss: __ Qty.: __ Property Code: Brand: Serial/OAN: Description (size,color,style,condition): Value: $ NCIC# Type Loss: __ Qty.: __ Property Code: Brand: Serial/OAN: Description (size,color,style,condition):. Value: $ NCIC# Type Loss: __ Qty.: __ Property Code: Brand: Serial/OAN: Description (size,color,style,condition):. Value: $ NCIC# Type Loss: __ Qty.: __ Property Code: Brand: Serial/OAN: Description (size,color,style,condition):. Value: $ NCIC# Type Loss: __ Qty.: __ Property Code: Brand: Serial/OAN: Description (size,color,style,condition):. Value: $ NCIC# Stolen / Damaged Veliicle Type Loss: V Color: ~,~ Year: LIY: O{ LIS:-ff'){ License: Description: Damage: Co.~.~ft ~c~-Y C~a~¥ ~.~'l~,C Value:$ Complainant Complainant(Perso.n/Business): ~(~0_ C",,txttaOc~ Business Representative (ifappL). Title: Address (if business): City State ~ Zip Age: _,~] Race: lad Sex: F Height: OFFICER NAME: '~x. O ' ~;:>C',~-~X ID# Page C-OP EIJL A 8 - ~ August 29, 2001 Ms. Joan McGuigan 222 Samuel Blvd., L-2 Coppell, TX 75019 Dear Ms. McGuigan: This letter is to notify you that your claim against the City has been forwarded to the 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 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, Vivygi6 V. Bowman Director of Administration/HR cc: Nancy Johnson Ken Griffin, City Engineer Jim Witt, City Manager Clay Phillips, Deputy City Manager 255 PARKWAY ~lr P O BOX 478 ~IrCOPPELL TX 75019 ~ TEL 972/462 0022 ~ FAX 972/304 3673 August29,2001 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 Joan McGuigan. If you have any questions, please don't hesitate to contact me directly at 972-304-3648. Sincerely, Vivyon V. Bowman Director of Administration/HR cc: Ken Griffin, City Engineer Clay Phillips, Deputy City Manager Joan McGuigan VVB/td 255 PARKWAY ~ P O BOX 478 1IrCOPPELL TX 75019 ~ TEL 972/462 0022 11~FAX 972/304 3673