ST9302-CL001002LAWSUIT/CLAIMS AGAINST THE CITY TRANSMITTAL FORM
DATE:
FROM:
DISTRIBUTION LIST:
Jim Witt, City Manager
Peter O.Smith, City Attorney
Vivyon Bowman, Director of Human
Resources
Texas Municipal League
Law.it File (origin&l/copy)
K?_
0
COMMENTS:
suit/city.form
revised 8/19/94
. -3
CLAIM NOTICE
PLEASE USE BLACK INK ONLY
(For Office Use)
CLUny[NO. /Ot~o~O00. !
OFFICE ~S ~ ~ DAY OF
~ ~~ SEnTrY
City Secr~ary
City ofCoppell
PO Box478
CoppeHTX 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 '~ I day of '~.~. ~'d~ , specific location of
~-~_~t~l, ;-0(, - ' , in Coppell, Texas.
2. The damage o..r injuf~ o~,c¥~ _ed. in the fgllowin, g~.~er~
The full extent of my damages and/or injuries are as follows (be specific - attach estimates, bills,
etc.,/f avail .abl~): _ ·
4. The amount of damages claimed is $
(Please Print)
I do swear the above is true and correct.
Signed ~~_/~(~/~J~F~'~- Date ~.~ 4. 1'7! ~"~{~0
NOTE: Artide 11, Sectqon 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 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 from 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 notiiication.
01398
Office (g72) 243-§g19
Pager (214) g33-384g
Fax (g72) 484-797§
RETANA BROTHERS
3022 Topaz
Farmers Branch, Texas 75234
~ CASH ~ECK ff ~V ~Z D CHARGE ~ ACCOUNT
QUANTITY ]ESCRIPTION PRICE EXT.
/
:- su~o,A~ ~ ~ 0 0
SlGNATUR~ _ ? v ~ - TOTAL
October 4, 2000
Ms. Bettina Patton
c/o National American Insurance Company
P.O. Box 38
Chandler, OK 74834
Dear Ms. Patton:
Enclosed please find two claims that have been filed with the City.
.~~Sinc , / ·
CCi
Encl.
Viyvon V. Bowman, Director of Administration/HR
Jim Witt, City Manager
Clay Phillips, Deputy City Manager
Ken Griffin, City Engineer
255 PARKWAY 'Jr P.O.BOX 478 "Jr COPPE:LL TX 75019 1[' TEL 9'72/462 0022 * FAX 972/304 3673
October 4, 2000
Mrs. Wendy Webb
308 Briarcove Lane
Coppell, TX 75019
Dear Ms. Webb:
This letter is to notify you that your claim against the City for the recent water problems
at your residence has been forwarded to the insurance company of the contractor working
on a project which caused this problem.
The name of the insurance company is:
National American Insurance Company
P.O. Box 38
Chandler, OK 74834
The name of the contact person is: Bettina Patton
Her telephone number is: 1-800-822-7802
Please contact Bettina with any comments/concerns regarding your claim.
S~~W,~rely'
'v'ivy~ V. Bowman
Diretfftor of Administration/HR
CC:
Bettina Patton
Ken Griffin, City Engineer
Jim Witt, City Manager
Clay Phillips, Deputy City Manager
25"; PARKWAY ~r P.O.IROX 478 1IrCOPPELL TX 75OI9 ~ TEL 972/462 0022 'k FAX 972/304 3673