ST9302-CL000920LAWSUIT/CLAIMS AGAINST THE CITY TRANSMITTAL FORM
DATE:
CLAIMANT/PLAINTIFF:
DISTRIBUTION LIST:
Jim Witt, City Manager
Peter G.Smith, City Attorney
Vivyon Bowman, Director of Human
Resources
Texas Municipal League
Lawsuit File (original/copy)
U
COMMENTS:
suit/city.form
revised 8/19/94
CLAIM NOTICE
PLEASE USE BLACK INK ONLY
(For Offic~ Use)
CLAIM NO. Oq_i!~_ D~O0,~. F~.~D IN MY~
o~ ~S ~ ~ DAY OF
~~ ~'~ SEC~Y
City Secretary
City of Coppell
PO Box 478
Coppell TX 75019
This is my notice of claim against the City of CoppeR. The 6rcumstances giving rise to this claim are a~
follows:
1. The injury or damage occurr_~l,, on the._~,'_~O~llay of ~ ..~~. /
at approximatdy ' o clock , at the specific location of,/~A°/,o~ .~'o _.< ~
It ! ' -
damage or injury occurred in the following manner:
3. The full extent of my damages and/or injuries are as follows (be specific - attach estimates, bills,
etc., if available):
,k~o,,,' u9 ~ ~'/~ ¢ t/s T~ ~vo ~/d t¢~ ~ht~ "r 0 tc F
/PW ',/' _ . - .-
-- - -- -"-'--as~es claimed is $ '/,~,~ ~ zgZ~ ~d),~3/'~' c)ff-
(Please Print)
I do swear the above is true and co_~. '
NOTE: Article 11, 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 mann~' spedfied shall
exonerate, excuse and ~empt the City fi.om any liability whatsotwer. No action at law shall be brought
against the City until at least sixty (60) days have elapsed following the date of notification.
Tuesday, September 19, 2000 10:31 AM ~
I & E SERVICES, INC.
1303 Foch Street
FORT WORTH, TEXAS 76107
(817) 335-5296
Primrose School
Attn: Bob McLaughlin
275 East Parkway Blvd.
Coppell, TX 75019
Terry Bierle 817-335-5296
Invoice # 18514
$ 128.28
Due Upon Receipt
AMOUNT ENCLOSED $
p.02
RETURN THIS PORTION WITH PAYMENT
Page # 1 REMIT TO: I. & E. SERVICES, INC. PREVIOUS E~ALANCE~ 00.00
................................................. ~,~, =~ ~, ~.,, ~.~8~i~O~: ~ ....... ~ ........... ;ii!~,~i~:'.~i:'~'~i'~,~i
09t07/00 SPRINKLER--LOCATE STICKING VALVE & REPLACE BAD 118.50
09/07/00 SOLENOID, CHECK THROUGH SYSTEMS, 0.00
09/18100 Fort Worth Sales Tax 9.78
LOCATED STUCK VALVE. REPLACED BURNED OUT SOLENOID
DUE TO SAND IN SYSTEM. CHECK ALL OTHER SPRINKLER
HEADS AND VALVES FOR SAND AND CLEANED WHERE
NEEDED.
TOTAL AMOUNT DUE
Currant Over 30 Over 60 Over 90
128.28
.... $ 128.28
~SAGES I COMMENTS