ST9302-CL000217CLAIM NOTICE
PLEASE USE BLACK INK ONLY
City Secretary
City of Coppell
PO Box 478
Coppell TX 75019
(For Office Use)
ICLAIM NO.
OFFICE THIS
CITY SECRETARY
F~.Fr~ I~ MY
DAY OF
This is my notice of claim against the City of Coppell. The circumstances giving rise to this claim are as
follows:
The injury or damage occurred on the
at approximately ;S:oo o'clock
'/~'~ day of ~s~. , Iqqq ,
P,~t , at the specific location of .~O~ t. Az~_
, in Coppell, Texas.
The damage or injury occurred in the following manner:
The ful(extent of my damages and/or injuries ar~ as follows toe si~:iflc - ms~h ~ hills,
etc., if available):
The amount of damages claimed is $
S'b-O
(Please Print)
Claimant ~
Address '-/z~ ~aO~ ~
Phone
City/State/Zip
NOTE: Article 11, Section 11.09 of the Home Rule Charter - Damage Suits. The notification shall be
filed within forty-five (45) days of the date of injury or damage or, in the ease of death, within forty-five
(45) days 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. No action at law shah be brought
against the City until at least sixty (60) days have elapsed following the date of notification.
Damage Assessed By: Bobby Lindley
Deductible: UNKNOWN
Insured: BRUCE MCDONALD
B&B AUTO BODY SHOP
606 W. Euless Blvd. Euless, TX 76040
(817) 040-0320
Fax: (817) 540-6645
Date:
Estimate ID:
Estimate Version:
Preliminary
Profile ID:
11116/99 01:39 PM
1764
0
B & B AUTO BODY
Mitchell Service:
Description: 1989 Oldsmobile Eighty-Eight Royale
Body Style: 4D Sed
VIN: 1G3HN54C6K1028637
910478
Drive Train:
3.8L Inj 6 Cyl AO
Line Entry Labor Line Item
Item Number Type Operation Description
1 024280 BDY REPAIR
2 AUTO REF REFINISH
3 000041 BDY REMOV~INSTALL
4 000043 BDY REMOVE/INSTALL
5 029490 BDY REPAIR
6 AUTO REF REFINISH
7 030330 BDY REMOVE/REPLACE
8 030410 BDY REMOVE/INSTALL
9 AUTO REF ADD'L OPR
10 933005 REF * ADD'L OPR
11 AUTO ADD'L COST
12 AUTO ADD'L COST
R REAR DOOR SHELL
R REAR DOOR OUTSIDE
R REAR DOOR MLDG
R REAR OTR DOOR HANDLE
R QUARTER OUTER PANEL
R QUARTER PANEL OUTSIDE
R QUARTER W/OPENING MLDG
R UPR QUARTER NAMEPLATE
CLEAR COAT
RESTORE CORROSION PROTECTION
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
Part Type/
Part Number
Existing
Existing
ORDER FROM DEALER
Existing
Dollar Labor
Amount Units
1.E'#
C 2.1
0.2
0.8
3.5*#
C 1.8
67.73 0.3
0.3'
1.2
0.2*
106.00 * $.00 *
* - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
Add'l
Labor
I. Labor Subtotals Units Rate Amount
Body 6.6 30.00 0.00
Refinish 6.3 30.00 0.00
Taxable Labor
Labor Summary 11.9
Sublet
Amount
0.00
0.00
Totals
198.00 T
159.00 T
357.00
357.00
Part Replacement Summary
Taxable Parts
Sales Tax ~
Total Replacement Parts Amount
8.260%
Amount
67.73
6.69
73.32
ESTIMATE RECALL NUMBER: 11/15199 13:38:55 1764
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: NOV_99_A Copyright (C) 1904 - 1999 Mitchell International
All Rights Reserved
Page I
of 2
ll' I 1' ~1 [
III.
Additional Costs
Taxable Costs
Sales Tax
Non-Taxable Costs
Total Additional Costs
8.290%
Amount
106.00
8.76
S.00
119.76
Date:
Estimate ID:
Estimate Version:
Preliminary
Profile ID:
IV. Adjustments
Customer Responsibility
11116/99 01:40 PM
1764
0
B & B AuTo BODY
Amount
0.00
I. Total Labor:
II. Total Replacement Parts:
III. Total Additional Costs:
Gross Total:
IV. Total Adjustments:
Net Total:
This is a preliminary ~st_imate
Additional chanqes to the ~_st.imate may be required for the actual repair.
367.00
73.32
119.76
660.07
0.00
660.07
ESTIMATE RECALL NUMBER: 11/16/99 13:38:66 1764
UitraMete is a Trademark o[ Mitchell International
Mitchell Data Version: NOV_99._A Copyright (C) 1994 - 1999 Mitchell International
All Rights Reserved
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