CLAIM TRACKING FORM
Date:
Claim Tracking Number:
Project: 2021 Paving Program - Arterial and Collector Roadways
Owner’s Contract Number: IFB0660-012821
All claims received by the City or the Contractor from the public in regards to the above
referenced project shall be documented using this form. The Contractor or their Authorized
Representative shall respond to the claimant within 7 calendar days of receipt of the claim and
within 7 calendar days after each follow up correspondence.
Claimant Information
Name:
Address:
Phone Number:
Email Address:
Date of Claim:
Description of Claim:
Contractor Information
Name:
Address:
Phone Number:
Email Address:
Date Claim Was Received:
Date of Response:
Additional Correspondence:
Description of Resolution:
IFBO660-012821
2021 Paving Program CLAIM TRACKING FORM
Arterial and Collector Roadways Page lof 1
