ST9302-CL000915 (5)LAWSUIT/CLAIMS AGAINST T~ CITY TRANSMITTAL FORM
DATE:
FROM:
70oo
CLAIMANT/PLAINTIFF:
DISTRIBUTION LIST:
Jim Witt. City Manager
Peter G.Smith, City Attorney
~ Vivyon Bowman. Director of Human
Resources
Texas Municipal League
L,~ F~le (original/copy)
COMMI~NTS:
suit/city.form
revised 8/19/94
CLAIM NOTICE
PLEASE USE BLACK INK ONLY
(For Office Use)
C~A~ ~0. D '~/~..~.0 oO. ~-'- ~.~n ~ ~
t ~
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 2 ~ a ? o"clock
The circumstances giving rise to this claim are as
.day of /~s,.~ , ~ ,
, at the specifi6 location of $ zo /:Jee ,~ ,,~ ~ ,l
, in CoppeR, Texas.
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):
4. The amount of damages claimed is $ / I 7 - ~,-'t~
(Please Print)
Address ,y 2~ c~ B ¢ ec~ ,~ ~ ~ L-^
Phone
City/State/Zip ~-...~¢ f '7 ,X" 7,..b-'""~ l .~
I do swear the above is true and correct.
Date ~ ./! ,2..~/cr'~
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 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.
406 HILLTOP LANE
DENTON, TEXAS 76205-3936
TEL: 972-733-0609
IRRIGATION REPAIR
INVOICE
320 BEECHWOOD LANE
COPPELL, TX. 75019-5303
Invoice Date Invoice Number P.O. Number Date Completed
09-12-00 09-I2-00
Quantity Deseripfion Unit Price
1.0 HRS. LABOR $ 54.00 $ 54.00
! MACHINE TO LOCATE VALVE $ 40.00 $ 40.00
PARTS $18.50
SECTION STUCK ON. LOCATED SECTION
VALVE. REBUILT VALVE.
SMALL STONES, SLIVERS OF RUBBER, AND
MUD WERE FOUND INSIDE THE VALVE.
TESTED SECTION. WORKED NORMALLY.
Sub Total $ 112.50
Tax $ N/A
GRAND TOTAL
112.50
TELEPHONE (214) 358-6581
FAX (214) 352-3201
ED BELL CONSTRUCTION COMPANY
POST OFFICE BOX 540787 10605 HARRY HINES
DALLAS. TEXAS 75354-0787 DALLAS, TEXAS 75220
September 22, 2000
Tim & Debbie Wesolowski
320 Beachwood Lane
Coppell, TX 75019
SEP 2 ? 2000
CITY MANAGER
CITY OF COPPELL
Re: Corrected Insurance Information
Dear Tim & Debbie:
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 'C
Chandler, OK 74834
Contact: Bettina Patton
Phone # 1-800-822-7802 ~
We regret any delay and inconvenience.
Respectfully,
Nancy Johnston
Administrative Assistant
ct. ~-~. oo
AN EQUAL OPPORTUNITY EMPLOYER
CC:
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