CLAIM TRACKING FORM
Date:
Claim Tracking Number:
Project: 2021 Paving Program - Residential Roadways
Owner’s Contract Number: IFB0660-021121
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:
IFBO660-021121
2021 Paving Program CLAIM TRACKING FORM
Residential Roadways Page 1of1
