ST9302-CL000915 (2)LAWSUIT/CLAIMS AGAINST THE CITY TRANSMITTAL FORM
DATE
CLAIMANT/PLAINTIFF:
DISTRIBUTION LIST:
Jim witt, City Manager
Peter H.Smith, City Attorney
Vivyon Bowman, Director of Human
Resources
Texas Municipal League
Lawsuit File (original/co~Y)
COMMi :
suit/city.form
revised 8/19/94
CLAIM NOTICE
PLEASE USE BLACK INK ONLY
(For Office Use)
I C~A]~O. O~lltS,2~O0, ~ ~.~n~"
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~ ., :2008
CITY CR~ARY ~
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
The injury or damage occurred on the
at approximately ~ o"clock
follows:
~ at the specific loc~tion o~, ~.~- ~L~Z/~ ark
, in Coppell, Texas.
The filil extent of my damages and/or injuries are as follows (be specific - attach estimates, bills,
etc., if avail~able):
The amount of damages claimed is $ '#S ~
(Please Print)
Claimant
Address
I do swear the above is true and co.rrect.
Signed Date ~ -- / ~ -0 0
NOTE: Article 11, Section 11.09 of the Home Rule Charter - Damage Suits. The notification sludl 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 notitication.
RETANA BROTHERS
3022 Topaz
Farmers Branch, Texas 75234: ~Cf(--
ADDRESS: ¢~
D CASH D CHECK ~ D CHARGE D ACCOUNT
O1428
Office (972) 243-5919
Pager (214) 933-3849
Fax (972) 484-7975
QUANTITY DESCRIPTION PRICE EXT.
SUBTOTAL ~ O o
TAX
SIGNATURE TOTAL ~ ~ O~
FAX (214) :~52-3201 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
David Laschinger
622 Lake Park Drive
Coppell, TX 75019
Re: Corrected Insurance Information
Dear David:
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: National American Insurance Company
Address: P.O. Box 38
Chandler, OK 74834
Contact: Bettina Patton
Phone # 1-800-822-7802
We regret any delay and inconvenience.
Respectfully,
Nancy Johnston
Administrative Assistant
AN EQUAL OPPORTUNITY EMPLOYER
"l'l I [ I[ - I
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
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