ST9302-CL000905LAWSUIT/CLAIMS AGAINST THE CITY TRANSMITTAL FORM
DATE:
FROM:
CLAIMANT/PLAINTIFF
DISTRIBUTION LIST:
/Jim witt, city Manager
Peter G.Smith, City Attorney
Vivyon Bowman, Director of Human
Resources
Texas Municipal League
L~suit File (original/copy)
COMMI NTS:
suit/city.form
revised 8/19/94
CLAIM NOTICE
PLEASE USE BLACK INK ONLY
(For Office Use)
CLAIM NO. ~ ~,~ 00 cb Fr,,mr) IN MY
OFFII~E THIS THE ~ DAY OF
I
CITY SECRETARY
City Secretary
City of Coppell
PO Box 478
Coppell TX 75019
This is my notice of claim against the City of Coppell.
follows:
1. The injury or damage occurred on the
at approximately ~o o"clock
The circumstances giving rise to this claim are as
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., if available): , ·
The amount of damages claimed is $ /P O. 0 0
(Please Print)
Claimant --]~g_~z t~
Address
Phone
City/State/Zip
I do swear the above is true and correct.
Signed .:~~ ~, ~ Date q" ~-"' DD
NOTE: Article 1 I, 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 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 notification.
THE NEW ROOTER
DALLAS, TX 75210
PHONE: (2 ~ 4) 421 --4306
PAGER: (972) 928-3252
39~d
Order No, NO. / ~
Name~
Addrese ~
ElY l CASH C. O O CHARGE I ON ACC T MD~;F_. RI'TO. I PAIO OUT ' ~
Quantity O E S C R I P T I O N PRICE A~tOUNT
I
I TAX "'
ALL cia, line end returned goods MUST be accompanied by this bill.
0726
3IMMIN
9£:1I
000S/1g/80
F'AX'(214) 352-3201 TELEPHONE (214) 358-6581
ED BELL CONSTRUCTION COMPANY
POST OFFICE BOX 540787 10605 HARRY HINES
DALLAS, TEXAS 75354-0787 DALLAS, TEXAS 75220
September 22, 2000
Terry L. Israel
129 Cherrybark Drive
Coppell, TX 75019
Re: Corrected Insurance Information
Dear Terry:
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