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ST0003-CS080826 Aug 26 08 01 :26p John Gay Tiseo Paving Co. (972)393-4650 p.1 /' ~ II < ~"-r cY c) -o:l ~~ PA.VING CCJIVIPANV M a ilin gAd d res s: P.O. ~ 0 x 2. i () () 40 D a 11 as, T X j 52: j PhysicaIAddr~ss: 419E.Ewi'.80 Mcsquite,TX 75150 T~~: (972; 289.Ci23 Fax: (972) 216-5637 FACSIMILE TRANSMITTAL SHEET TO: '. "Jd, "\ ICe, {)1,~~ CO JY.lP Al'J""i": C. 0.. ~L-I F J...:x 1',iU}I.l:BER: FROM: ~ ~~ P... ("" I/kJ DATE: 8"2~"CS-S TOT.:u... NO. OF Pi'...G3S I~CLUDrnG COv.=1\.: y RE' Do.. \It · d ... S ~ +'4. o URGE~': 0 Fot P2~"-:EW o P:'EASE :OM1..GNT :J P:"EASE P.EP:S-:' o ?:"EASE F.ECYCLZ )-IC':'E.S/COMUa..~S; P.O. BOX 2iOHC D.\LL....S. T: 1SZ~i Aug 26 08 01 :27p John Gay Tiseo Paving Co, (972)393-4650 p,2 To: Tiseo Paving Company P.O. Box 270040 Dallas, Texas 75227 Atten.: Randy Sabella From: David E. and Joanne P. Smith 412 S. Coppell Road Coppell, Texas 75019 RE: Electrical surge into private residence causing burned electronics To whom it may concern: On July 30, 2008 at approximately 6:45 a.m., we were awakened by a gravel hauler across from our home leaving a load for tbe construction on South Coppell Road. I looked outside to see what was going on when horns started honking and workers yelling. I heard noises out of my computer and a CD player spinning and making noises. By the time I got dressed and ran outside, the trucker was gone and our power line ).vas hanging about 5 foot off of the ground. I went in, got my husband up and he turned off the breakers. I went back outside to find out what happened and one of the crew from North Texas Contractors, Kris, gave me a paper with the license plate number and truck number ofthe driver from Marietta. He had to follow him and have him stop since he left the area ",:ithout checking if anything had gone wrong. OnCor was called out by both North Texas Contractors and ourselves. They arrived about 30 to 40 minutes later. The neutral of the power line and support had been broken. This caused a 240 surge into our home one phase of the power line. This is according to Oncor. When we came back inside I could smell smoke still in the house, My husband tracked it down and found several surge protectors burned. Further investigation found several pieces of electronics had burned, We were very lucky that the house did not catch on fire. We feel it is the responsibility of the trucking company to reimburse us for the damages incurred by one of their drivers, We Lost a TV, StereQ surround sound system, DVDNCR player, washer, two Verizon boxes and several surge protectors. The estimated cost to replace these items in today's market is around $2,500.00. This is not including our time and effort having to estimate these items, waiting for Verizon to come and replace what was needed and repair men from Sears. We hope this will be taken care of in a timely fashion. Sincerely, David E. and Joanne P. Smith Aug 26 08 01 :27p John Gay Tiseo Paving Co. (972)393-4650 p.3 Au~ 20 2008 1:41PM .. Gu~ Luna Insuranoe Rtenc~ S726133671 fl- 1 ACO~D... CERTIFICATE. ~ LIABILITY INSURANCE 1'HIS CERTlf'ICATE: \S I UED AS A MAlTER Of INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA1E HOLDER. THIS CERnFICA"T"E DOES NOT AMENO, EXTEtm OR ALnR ~E COVERAGE AFFORDED B'r' THE POUC1ES eEL-OW. '11 ~OUCEII '---UY LUNA INSURANCE AGENCY 224 19-30 JlaS't, Suite 132 1 Mesquit:e, 'rX '75150 9 2 3-49 I' tlSUR6D J'l'M Maurj,a~s, lno_ ll. O. BOI 2496 Danton, TX 16262 NAIC I : "'eUflef\ It INlIUFI&f'. B; INSUIIEI\ c: IIlSUlEA II 'NSUReR Eo COVERAGES THE POUCIES Of '14SURANCE \.1S'TEO BELOW HAVE BEEN ISSUED TO TrlE INSlJR~O HAMEll ABOVE FOR THO. POLICY f>EP.IOD INDICATED. NOTWITHSTANOr-lG Al'IY ReaUIREWENi". lERIoI OR CONtlIilON OF M-iY CONTRACT OR OTHER OO:UMEH'T VIIITH RESPEC'" TO WHICH TH~S CERTFICATE MAY SE lSSUEO OR MAY PERTAlN. THE INSUfV,~CE AFFOROEO 8'l' THE POUClES DESCflJ6!;D HEiRElN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS A'll) CONDITIONS OF SiJCtI POl.ICIES. .o.GGREGA'fE LIoITS SIiCM'fl MA'l'HAVE BEEN I\S)lJCED BY PAlO ClAIMS. pOLle'!' NUhMlER A I Y EFFECllVE f>~ICY EXPlflAllO~ LIt.lIT5 OEtoEFW. \.IAllLlTY ~ E Mf:O EXP (Anv _por",,") S pe~ a Ar;;v INJURY . l IJeNERJOl "ClGR~QA11: ' $ PRODUCTS - COl\"IPIOP AOO 1 A CL42D50206B 101 U/:2007 1.l>!19/200B we A OEOUCTll'lI.E AETENTI~ $ wORl<Sla COIolFvr.lAT IO/U>oNO EMPLOveI\ S' lIA1lltl'l'V JJN _'ErCllll'''''''~ C ; 0I'f'1CI!.AIIIW8!!R l!llCl.UOCC'l "~C~~IIIStolC/W OTHER WC9S25 COIII\llNEC I>IIoIGLE L...IT $ 1,GOO,OClO I IE. .ccloenl) I I IIl<lIltLYINJURV 110/1.9/08 ' IPorperoonl 10/19/07 aOOll Y INJURY I tP8~accidert) I PROF'ER'l"Y CAMI\Ge (P_IIO<;o.,,,,,) ...UTCQIC\..... .EAA.tCIJENT $ OTHER THAN eAACC $ , .\UTOONt",: AGG I EAJ:H OCCURRENCE $ il\OOREGATE J 10/19/0j 1 iOn 9/08 ! 10/19/07 10/19/0B E.~. DISEAS E . I!A EWIl'1.CI'l"E 1 E." DI$EASE. POLICY ul.ur 1 09335909-3 EXCESSII.MIIIU:I.LA ~lABLlTV ::iJ OCCUR 0 CV.IMSMllDE XMS04747 onCRlPTIO'" OFOP€'RATlONS/lOCATIONSrvEMICLE6 {EXCLUSION!> AOOEC BY ENOORSEIllENT 'SPECIIIl PROVlSIONS l CERTIFICATE HOUlER Nort.h 't'eX.. conuacting Attn: Linds&y 4999 ae~ler Has~e~t ad ~s1~&~, ~&~as 76248 Vi. PaK~ 517-430-1220' 9'O-2.~-8S~1 EllA TlON tHOUItl AN'f OF 1l1E AIIev. OESCRIBfD POL ICIES ~ C;IItOELLED BEFDIE nE E./CPIAA.TIOfI o.o.lE THERE!)F, THE ISSUING iNSuRER w<<'L I:NDEA\IOR TO UAlI..l!L.. DAVS Wltmnl I'KlllCE TO T~E CERTIFICATE HOLDER rw.'lE~'fO THE LEFT. BlIT FAl"URE TO 00 so SHALL '"'POSE NO 08LIGATI0III OR LlAet.lTV :IF AIo{'f KINe UPON THt lI'1SURER, 1'1'$ AGeNTS ~ Ji.EPIlESENTATIIIES IZfD AE SENTATIYE L- '" ACQRO COf\PORATION 1984 ACORO 251ZDCllIOIi Aug 26 08 01 :27p John Gay Tiseo Paving Co. (972)393-4650 pA ;/ NORTH TEXAS CONTRACTING, INC. NTC LINE CUT REPORT Date:~ Job Number: () ~ J.s-- Job Location: 5 C~ff c.1l rJ.... i--- k 1A.y' t.... Sf-. / Incident Details (be as specific as possible): At- 0(., 4:G 0.. j fa v ..\ t r.J die b "Ion :l ~ n,j-t" /Yi ~,f-; '" -IYI ,,,,'.,#-CA- WCl5 u(\lo~,.bflj OL lOGlc.L "+jr"lve.l. 6'" .+kc.- wes+ 6~J.~ o-P- l:_~W\\ ~...cL. (15 -t~,- t rvJc.. """.;;_J,;'j {. rlW~ wh;1 l- et\! M f ;n" fh... Ia.."l/:th e. rm's_.J.- ,or-h." o-t Cfl. L n~;vll- r,o.v"n-l ".. ""'e~ he."J- rflOnL /;"e.. 1'1.;5 ~f'-J"," fJllwl 00 -rIa, 1'. k ,,+ --t h <- -"s <- d; ,n I wh:" h t h Of' f v JI."c -th!... \\.rJ~V+r4,l)I fower' I;nt. .,\1+ of -/-JH.. e,,Aifl'or hox Q.f> -IhL )1 o...tS e..... "y'l -+ h L- Co fi) "'" · )<..ris L.vct VII; '1 ~ll1.!. +-..\ c.,ha6 {... clovl'l -t-hv veJ)",Ie.- - ;11 ctJer +0 je.+ hL& ~n-~O, jht... UC~(l.s.(.1'~~+e.- (II- tht, frut.-k j'~ )(.17-70~) -the.. -frvJe:. i-tse-l.p t.v~ nvrnbef' '19 L ]J1c.. (t~~Jeote. InvDJvevl.. VVL\.& 4-1l- 5, CGfr~H r-cc:(.~, Claim! Reference # (if available): . . . c.Ji-.+ Oe1tllnlJ eo Contact Name / # of Utility Rep: Cl1(' Ifo".J FaiN - (j"'~D4.. / m,~~4;,.J 1rl1l>"'~#A. Cfll(J2 43 't;51.S , . Status: IH \ r el a iT.!> . ~ <<. c! e..- ~~ Signature of NTC Rep. Got', B;J..4J'-'/ , I Printed Name 4999 ~r Haslet Rd. Keller, TX 76248 . P.O. 80x 468 Keller, TX 76244 . 7) 4JO-9500 . Fax (Bi7) 430-9207 Aug 26 08 01 :28p John Gay Tiseo Paving Co. (972)393-4650 p.5 ...../ N(JRTH TEXAS CONTRACTING, INC. N1:'C LINE CUT REPORT Date: Job Number: Job Location: j Incident Details (be as specific as possible): T + ~.s.o.,n .Lb 'f U,.v.'o\. S",; +1., to.L h.s. ",j-i' <-I +~ · j r fhl>Ilt.- nvtnht. .;s '172.-4-4.2-- L't.I~.. c"tJI'J+o,v r=ct:N I'~ +h(., C>NCO(J..((;P w~o. eClme +0 -the. G 1ft.. at) re.-a#C4 (;..~, cL. th t I~., L- +.c> +h e. Sm i + h r~i Jen C( I a.1.sD ('Ikcvl~;nj -to r'H~.'Jf-e. .surt.. fhct+- ~j( fJ.p. -the, COfte-v} el~cA-r~ ~Cl;l 'CIJr (~n+...s. .~ W'~I'e...' ;f\ j.lil-ce., C J 'I1+Dt L-IJ'''''j e- j'::, + h t- . c"t'\f I.' ~ net.. rrf.t; c-e,t- -to r S he~- JorJltN,I who Nfre,} e ,,-/-.:> m_,.+?1J - rn ei-r,tJl ~ . 1-1 e.. hCl.J. a,\~~ a,.r,vf.J-. 6" -si+e-1..:? ~~" -fhel r' i (,\V6-+~j4.t-~ 'JpJ Claim! Reference # (if available): Contact Name! # of Utility Rep: Status: .-- Signature of NTC Rep. Printed Name 4999 .lr Haslet Rd. Keller, TX 76248 . P.O. Box 468 Keller, TX 76244 · 7) 430-9500 . Fax (817) 430-9207 Aug 26 08 01 :28p l(.f~"r1(" ~ 0 fO\~ John Gay Tiseo Paving Co. ~ ~ - -- 00) ~ c '-.) ... \n t)ve.the.~J.. fh~"e., ~I'lc.l feV"er 1 ,'", "oS . '---.---- -....------ to t DGr4.vt.1 T(' 11'- k (972)393-4650 p.6 Nt 4\2... S, C.Drf~ II ""' ~ E" I,d,.! c.~ I pay ... ~+;:"j;P~": fQI~ kA YG. St.