New Claim Notification Log
Date of Discovery
Project of Location
Specific Location
Intersection/Cross Street
Subcontractor
Cost Impact
YES
NO
Subcontractor CO#
Schedule Impact
YES
NO
MAYBE
Schedule Activity Impacted
New COST CODE
Contact Date/Time
Claim Title
Description
MTC Team
Please Select
Construction - Civil
Construction - Stations and Stops
Construction - MSF
Construction - Track
Construction - Systems
Construction - Dry Utilities
Construction - Structures
Construction - MEP
Technical - Design
Technical - Permits
Claim Type
Please Select
Mislocated or Unknown Utility
Contamination
COVID-19 Impact
Design Related
Other
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Mislocated or Unknown Utility
Mislocated Utility Item #
Brief Description of Mislocated or Unknown Utility
Type
Unknown
Mislocated
Unknown and Mislocated
Type of Utility Discovered
Size (Diameter)
Service Connection?
YES
NO
Street Light or Traffic Signal Cable
YES
NO
Type of Work Being Completed
Please Select
Dry
Wet
Structural Excavation
Excavation
Other
Date of discovery of Mislocated or Unknown Utility
-
Month
-
Day
Year
Date
Items Pending
Please Select
3
4
5
6
7
8
#1 - Detailed Description - Status
Please Select
Complete
Pending
#1 - Detailed Description - Responsible
Please Select
Construction Team
Responsible
#2 - Locates - Status
Please Select
Complete
Complete
(avlble in letter)
Complete - In Letter
Pending
Status
#2 - Locates - Responsible
Please Select
Construction team
Responsible
#3 - Identity of Owner - Status
#3 - Identity of Owner - Responsible
Please Select
Construction team
Responsible
#4 - Confirmation of Ownership and Status
Please Select
Partially Complete
Pending
Complete
#4 - Conf of Ownership - Responsible
Please Select
Construction team
Responsible
#5 - Photographs - Status
Please Select
Complete
Need more detail
Pending
#5 - Photographs - Responsible
Please Select
Construction team
Responsible
Update?
#6 - Bid SUE Data - Status
Please Select
6
Complete
(Avlble in WD)
Complete
(avlble in letter)
Complete (in letter)
Pending
Status
#6 - Bid SUE Data - Responsible
#7 - CAD Drawings - Status
Please Select
7
Complete
Pending
Status
#7 - CAD Drawings - Responsible
Please Select
Construction team
Dalia Youssef
Responsible
#8 - Cost Impact High Level
#8 - Invoices or Cost Impact Data - Status
Please Select
8
Complete
Pending
Status
T&M summary from Aecon in Letter.
#8 - Invoices or Cost Data - Responsible
#9 - Schedule Impact Analysis Required?
Please Select
Yes
No
Maybe
#9 - Schedule Analysis - Status
Please Select
9
Complete
Pending
Status
n/a (only a few hour delay)
#9 - Schedule Analysis - Responsible
Please Select
Arun
Responsible
#9 - Schedule Activity Affected
Contamination
Category of Impact
Please Select
Worker or Crew Exposure
Worker or Crew Positive Test
Subcontractor Hygiene Measures
MTC Hygiene Measures
Supply Chain Impact (material/equipment)
Other
Date of Impact of COVID-19
-
Month
-
Day
Year
Date
Details of Foreseeable Consequences
Other Pertinent Documents
Status (COVID)
Complete
YES
NO
Additional Comments
COVID-19 Impact
Specific Area
Sketch of Area
YES
NO
Type of Contamination
Testing Documentation
YES
NO
Approximate Volume
Plan for Excavated Material
Current Plan for Excavated Material
Subcontractor Involed
Cost Details (CO, Invoice, DWR, Tickets )
Other Impacts?
Design Related
>> Design and Other
Description of Potential Claim
Cost Impact of Claim
YES
NO
Cost Impact Details
Schedule Impacted by Claim
YES
NO
Schedule Impact Details
Claim against?
Please Select
CA
Designer
Other Impacts
Other
Item pending
Please Select
3
4
5
6
7
8
Break
Submit
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