ST9302-CL000918CLAIM NOTICE
PLEASE USE BLACK INK ONLY
(For Office Use)
CL,~Vi ~O. tgq 1~' ZOO O im.~n n,r MY
OFFICE Tiffs THE / ~' DAY OF
CITY SECRETARY
City Secretary
City of Coppell
PO 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 2/q~) day of
at apprgximately ~' o"clock ,4.36. , at the specific location of
(o2o ])~.go~-r- ?-.b, ' , in Coppell, Texas.
The damage or injury occurred in the following manner: .
The full extent of my damages and/or injuries are as follows (be specific - attach estimates, bills,
etc., ii'available):
4. The amount of damages claimed is $
(Please Print)
Claimant ~
Address
NOTE: Artidle 0 -
, SY~io . 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 case of death, within forty-five
(45) days of the date of death. The failure to so notify the City within the thne and manner specified shall
exonerate, excuse and exempt the City fi-om any liability whatsoever. No action at law shall be brought
against the City until at least sixty (60) days have elapsed following the date of notification.
INVOICE
BENNETT IRRIGATION
3003 Ravine Trail
Carroilton. TX 7,5007
[972} 394-9964
Customer Name:
Address:
Home Phone: ? 5,'~-Yo'f~ Wk: q
Date: ,i-~-eo ,. ?-?-¢o
Sprinkler Repair/Maintenance
Description of the services performed are listed below:
Amount
Total: $ '-/0'/. o._o..,.
Thank you for your business: