ST9302-CL000907LAWSUIT/CLAIMS AGAINST THE CITY TRANSMITTAL FORM
CLAIMANT/PLAINTIFF:
DISTRIBUTION LIST:
~. Jim witt, City Manager
Peter G.Smith, City Attorney
Vivyon Bowman, Director of Human
Resources
Texas Municipal League
t Fi~e (original/copy)
COMMENTS:
suit/city.form
revised 8/19/94
CLAIM NOTICE
PLEASE USE BLACK INK ONLY
City Secretary
City of Copper
PO Box 478
Coppell TX 75019
This is my notice of claim against the City of Coppell.
follows:
_ (For Office Use) , ,
C'LA~NO. (.)c;/~7,,~Ot30. I ~.~nINMY|
ONCE ~,-~s ~ q~_' -rAY oF/
R'ECEIVED
SEP 0 ? 2000
CITY SECRETARY
The injury or damage occurred on the 3 0 day of
at approximately I 0: oo o"clock 1> n~. , at the specific location of
, 2~000 ~,
, in Coppell, Texas.
The dan}age or injury occurred in the following manner:
~/~-~ 4~ 4'e~i,~¢~ c~-,~e
~e ~ e~ent of my d~ag~ ~or ~jud~ ~ ~ fo~ows
~c., ~v~le):
~e ~ount ofd~ges cl~ is $ [~1.~1
(Please Print)
Claimant L
Address
/ z.o ~J~0~c.~+ L~
Phone (qqz- / 3?3- z.z 09
City/State/Zip f _d P pCL. l_.,--'fiX. /75'0 ICi
I do swear the above is true and correct.
Date
NOTE: Article 11, Section 11.09 of the Home Rule Charter - Damage Suits.
q/(e/I-
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.
Purchase Order Cf:
Requested ..By: ¢.,?/05/00
Order Taken B~ERV
Delivery / Service Ord.'
Service Man
017~59
RA~ciSEY C/LANt
t20 WOODCREST
COPPELL TX 750t9
H ~72>4~2-~03~ W (~72)3~3-2207
Delivery SEE FtEMO~
Instructions
Code: FC Desc: FILTER CHCff4GE
Service PLEC~BE CHRN6E FILTER'S lr4CiKE SURE ALL IS WORKING
Requested
i~Gpy: ~/~/9~
~bie~: FC FILTER
AIR TO
;tEN. ~f~, FOR F1LTE~
;+~ion: ~ T~ ~/CtTY
.tER~TI~TB P~
Subject to terms and conditions on back
T
878 Pd~RTICUU~TE FILTER
~81 P~RB{I~ FILTER
RB8 ~TC;{EBO{4 FILLER
Total Parts
Service Call Cha~.e
Labor ~-~/'~ ~ hrs @¢,' ./~
Mileage __ miles @ ~ (~'
Hour
/ mile
Sales Tax On
Total This Call
(Subtotal)
0 - 30
~. 88 0.88
Previous Balance
TOTAL DUE
Payment Received __ cash ~ check
Comments:
Serviceman Signature ¢//
Date
{ba~e
(214) 352-3201 TELEPHONE (214) 358-6581
ED BELL CONSTRUCTION COMPANY
POST OFFICE BOX 540787 10605 HARRY HINES
DALLAS, TEXAS 7.5354-0757 DALLAS, TEXAS 75220
September 22, 2000
Lani Eddins
120 Woodcrest Lane
Coppell, TX 75019
Re: Corrected Insurance Information
Dear Lani:
Ed Bell Construction Company is concerned that the City of Coppell has misinformed
you regarding insurance information for your claim. They did not contact us prior to
referring your claim. We have forwarded your claim to the correct insurance company.
You may contact them at: -
Insurance:
Address:
Contact:
Phone #
National American Insurance Company
P.O. Box 38
Chandler, OK 74834
Bettina Patton
1-800-822-7802
We regret any delay and inconvenience.
Respectfully,
Nancy Johnston
Administrative Assistant
AN EQUAL OPPORTUNITY EMPLOYER
CCi
Ken Griffin, City Engineer
Clay Phillips, Deputy City Manager
Jim Witt, City Manager
Vickie Boyer, The St. Paul
Bettina Patton, National American
Ricky Main, M-Co