ST9302-CL010703 LAWSUIT/CLAIMS AGAINST THE CITY TRANSMITTAL FORM
DATE:: 7- 3
CLAIMANT/PLAINTIFF:
DISTRIBUTION LIST:
~im 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
1' H E C I T Y 0 F'
C-OPPg £
A S ~'
July 9, 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 William E. Pease. We do have photo~aphs available.
If you have any questions, please don't hesitate to contact me directly at 972-304-3635.
Sincer~y,
vivyo~ffV.~Bowman
Director of Administration/HR
cc: Ken Griffin, City Engineer
Clay Phillips, Deputy City Manager
William Pease
VVB/td
255 PARKWAY ~ P 0 BOX 478 ~ COPPELL TX 75019 ~ TEL 972/462 0022 ~ FAX 972/304 3673
CLAIM NOTICE (For Office Use Only)
CLAIM NO. ~70 32001. J FILED IN
MY,~). F.FICE TI2IIS THE 3 ~; ~ DAY OF
~ ~. I~- -, ,20o/
DEPUTY CITS" SECRETARY
City Secretary
City of Coppell (972) 304-3673 (FAX)
P.O. Box 478
Coppell, TX 75019
This is my notice of claim against the City of Coppell. The circumstances giving rise to this claim
are as follows:
1. The injury or damage occurred on the ~ day of ~/~/. ,20 tv/, at
approximately .'qC't'P o'clock o,.~-~-. , at the specific location of r. Ca,~-r/,~
,~f :-'A~,~ .57? ~-~ /_.~Z~ oe~. /J/P¢~ '~,2~4'd~'~.0 - , in Coppell, Texas.
2. The damage or injury occurred in the following manner:
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3. The full extent of my damages and/or injuries are as follows (be specific - attach estimates,
bills, etc. if available):
- . .- -~:.
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4. The amount of damages claimed is $
(Please Print)
Claimant ~)~L~,o,.-- ~'. 6~/0Y~ Phone (9 ?2_ ) ff(~ 2-- 7/ ~/
Area Code
Address '~.3'? ~,07-~3,,~ ~)'/,.~w._ CitylStatelZip Ce:~o_ .P~,c,?34. (Also list previous address if less than 6 months)
I do swe~ correct.
Signed ~~ Date /
The notification shall be ~ed within six (6) months of the date of injury or damage or, in the case of dehth, within six (6) months of
the date of death. The failure to so notify the City within the time and manner specified shall exonerate, excuse and exempt the City
from any liability whatsoever. (Article 11, Section 11.09 of the Home Rule Charter - Damage Suits)
Revised l 1/00
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T H ~' ¢ ! T ¥ 0 F
COP?ELL
July 9, 2001
Mr. William E. Pease
937 Fountain Dr.
Coppell, TX 75019
Dear Mr. Pease:
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, ,
Dir~tor of AdministratiorffHR
cc: Nancy Johnson
Ken Griffin, City Engineer
Jim Witt, City Manager
Clay Phillips, Deputy City Manager
255 PARKWAY ~r P.O BOX 478 ~- COPPELL TX 75019 ~ TEL 972/462 0022 ~ FAX 972/304 3673