ST9302-CL000928 (2)LAWSUIT/CLAIMS AGAINST THE CITY TRANSMITTAL FORM
DATE:
FROM:
CLAIMANT/PLAINTIFF:
DISTRIBUTION LIST:
Jim witt, City Manager
Peter O.Smith, City Attorney
Vivyon Bowman, Director of Human
Resources
Texas Municipal League
Lawjit File (original/copy)
COMiC_aNTS:
suit/city.form
revised 8/19/94
09/07/00 11:00 CITY ~ NO.5B2 P002
O~OPPELL ~ 9?2 556 6948
CJ~AIM N,O,,TICE
PLEASE USE BLACK INK ONLY
{For Olfio~
O..AIMNO,
OFFICE ~ ~ -- DAY
~~~ . ,_~ .
' I
Cit~S~r~tary
CityofCoppdl
POBox478
CoppdlTX 75019
This is my notice of claim a~pdmt the City of Coppoll.
follows:
¢
Tho dmase or injury Occurred in ~ .followinS m~:x ~wO cO
Thz full extent of my dam~es and/or injudo~ are u follows (be ~pociflo - attnoh eedmat~ bili~,
.~available):
The mount ofdanu~ges olnimed ie $_ ~"~'-
(Please Pri.~
NOTE:
filed within
tlo I 1, Seotion 11.09 of tho Home Rule Chartnr - Dsmal~ Suits. The notification shall be
~rty-fivo (45) days of'tho date of injury or dan~a or, in tho ~ of do~th, within
(4S) days of the date of death. Tim failure to no notify the City within the tirrm and nmnner specified shall
exonerate, excuse and ~xempt the City from any liabih'ty whtaoevar. No ac~on at law shall be brou~t
against the City until at least sixt7 (60) days have elapsed following the date ofnotification.
O0
CUSTOME
NAME
ADDRESS
IIOTtl-
CITY
PHONE NO. ( )
- ~,~_ · OURTESY INSPECTION
(x ,
FIXTURE OK NEED
SERV.
MAIN LINE
2315 Luna I~1,, #126 · Carrollton, TX 75006
(972) 241-5808 · FAX (972) 241-6046
PLUMBER'S LICENSE # M-15128
'ervice & Plumbing Co.
JOB#
NAME ,.
ADDRESS
CITY , /?
INVOICE DA 086803
DATE L ,,~
SERVICEMAN NO. >¢ / >
STATE""/?'
STATE
ZIP CODE
[]VENT
TOILET
BATH TUB
SHOWER
BATH SINK
KITCHEN SINK
DISPOSAL
LAUNDRY
}RINAL
~LOOR DRAIN
FLOOR SINK
AREA DRAIN
WATER HEATER
~:CLEAN OUT
PHONE Nb.'(
[ [] YES
) ZIP CODE -':2~ ,:),/~:~
GUARANTEE NO:' t E IN /' '":/'~ / '(/'~
_ ~.-'_. TIME OUT
CAUSE OF S~O~AGE
[] ROOTS [] GREASE
[] OTHER I-- UNKNOWN
~[~ OVERTIME
DRAIN CLEANING
ADDITIONAL FOOTAGE
ADD'L FIXTURES ~
)
QTY.
DESCRIPTION / REMARKS
PLUMBING LABOR
PART~
PRODUCTS
PART NO.
TOTAL
I
PAYMENT RECEIVED
929 E~tst 41st Street, Austin TX 78751
aFC (512) 458-2145
CUS'I':OM E R COPY
( ,, .:~' ) ;,'-,%,-~. ,
·AUTHORIZS'0 SIGNATURE
SIGNATURE ACKNOWLEDGEMENT COMPLETION
EXCELLENT ~ SATISFACTORY 0
I hereby authorize the above described work to be performed by Rata-Rooter and agree to all of the terms and conditions set forth above and on the
reverse side hereof. I recognize that aged deteriorated plumbing fixtures or piping, settled, broken or off-set sewer lines may no longer be serviceable and
further agree to hold Rata-Rooter harmless for any damage or destruction thereto or arising therefrom. I agree to pay for all work, goods, and services
received in accordance with the terms stated herein.
TERMS: Net 10 days. An account maintenance fee of 1 1/2% of th~' outstanding balance per month (18% annual percentage rate) will be added to
o amounts not paid within 10 days of invoice date. A $20,00 charge is added far all returned checks.
.Texas State Board of Plumbing Examiners
PARTS
DESCRIPTION
PRICE
[] CASH [] CHG
[] CREDIT CARD
CC #
VIDEO INSPECTION
HYDRO-JETTER
MINI JETTER
LINE/LEAK LOCATION
APPROV. #
October 2, 2000
Ms. Bettina Patton
c/o National American Insurance Company
P.O. Box 38
Chandler, OK 74834
Dear Ms. Patton:
Enclosed please find another claim that has been filed with the City.
Administrative Support Supervisor
CCi
Encl.
Viyvon V. Bowman, Director of Administration/HR
Jim Witt, City Manager
Clay Phillips, Deputy City Manager
Ken Griffin, City Engineer
255 PARKWAY 'JrP.O.BOX 479 ~' COPPELL. TX 75OI9 ~r TEL 972/462 0022 lfrFAX 9?2/304 3673
October 2, 2000
Ms. Jonna Smith
609 Raven Lane
Coppell, TX 75019
Dear Ms. Smith:
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:
Her telephone number is:
Bettina Patton
1-800-822-7802
Please contact Bettina with any comments/concerns regarding your claim.
Sinc. erely, t
Director of Administration/HR
CCi
Bettina Patton
Ken Griffin, City Engineer
Jim Witt, City Manager
Clay Phillips, Deputy City Manager
255 PARKWAY 'A"P.O.BOX 478 'A'COPP£LL.. TX 75019 ~ TEL 972/462 0022 'JrFAX 972/304 3673
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