New Claim Notification Log
Claim Type
*
Please Select
Contamination
COVID-19 Impact
Mislocated or Unknown Utility
Design Related
Other
Name
Date of Discovery
*
Project Location
*
Specific Location
*
Intersection/Cross Street
Subcontractor
*
Subcontractor
Which subcontractor was completing the work?
Cost Impact Does the impact result in additional costs?
*
YES
NO
Cost details
*
Subcontractor DWR, CO's, Invoices (Please upload if available)
Subcontractor CO#
Schedule Impact
*
Please Select
Yes
No
Maybe
Will the impact result in a potential delay?
Schedule Activity Impacted
New COST CODE
Claim Title
*
Project Area
*
Please Select
Part A
Part B
Part C
Part D
MSF
Humber College
Finch West Station
Segment 1
Segment 2
Segment 3
Segment 4
Segment 5
Segment 6
Segment 7
Segment 8
Segment 9
Segment 10
Block 2A
Block 2B
Block 2C
Block 2D
Block 2E
Block 2F
Block 3A
Block 3B
Block 3C
Block 3D
Block 3E
Block 3F
Block 3G
Block 3H
Block 4A
Block 4B
Block 4C
Block 4D
Block 5A
Block 5B
Block 5C
Block 5D
Block 5E
Other
N/A
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
Cost Details (CO, Invoice, DWR, Tickets )
*
Is there a hauling summary available? Tickets, CO's, Invoices?
Cross Street or other landmark
Schedule Impacted. Was worked paused?
*
YES
NO
Description of Potential Claim
*
Cost Impact of Claim
*
Please Select
Yes
No
Cost Impact Details
Schedule Impacted by Claim
*
Please Select
Yes
No
Schedule Impact Details
Date of Impact of COVID-19
*
Date of discovery of Mislocated or Unknown Utility
*
Brief Description of Mislocated or Unknown Utility
*
Cost Impact High Level
*
High level impact of cost (standby time, redesign, utility support, potholing, other.)
Invoices or Cost Impact Data - Status
*
Please Select
8
Complete
Pending
Status
T&M summary from Aecon in Letter.
Please provide supporting DWRs COs, or Invoices.
Are details currently available?
Please Select
Yes
No
Schedule Impact Analysis Required?
*
Please Select
Yes
No
Maybe
Please indicate if you believe that there is potential that discovery caused delay.
Please Upload All Relevant Backup Data
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Sketch of Area
YES
NO
Type of Contamination. If available.
Testing Documentation. Is testing documentation available? If so please attach.
YES
NO
Approximate Volume
*
Approximate volume excavated.
Plan for Excavated Material
*
Current Plan for Excavated Material
*
Where are we taking it now?
Subcontractor Involed
*
Other Impacts?
*
Can you identify any other impacts on how we planned on doing the work, versus how we actually completed the work due to the discovery of contamination?
Schedule Activity Impacted
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
What type of COVID impact was encountered?
Mislocated Utility Item #
Type
*
Unknown
Mislocated
Unknown and Mislocated
Type of Utility Discovered
*
Indicated, to the best of your knowledge, what type of utility that was discovered.
Type of Work Being Completed
*
Please Select
Dry
Wet
Structural Excavation
Excavation
Other
What type of work was being completed when the utility was discovered?
Size (Diameter)
*
Please attempt to measure size or diameter of discovered utility.
Street Light or Traffic Signal Cable. Is the utility cabling for street light or trac signals?
*
YES
NO
Service Connection? Is the utility a service connection?
*
YES
NO
Locates - Status
*
Please Select
Complete
(avlble in letter)
Complete - In Letter
Pending
Status
Please attach relevant locates.
Identity of Owner - Status
*
Do we have any indication who the utility belongs to?
Confirmation of Ownership and Status
*
Please Select
Partially Complete
Pending
Complete
Do we have written conrmation from utility owner conrming ownership?
Photographs - Status
*
Please Select
Complete
Need more detail
Pending
Please provide photographs or video that provide context to the situation (location, street sign, measuring tape, etc.).
Bid SUE Data - Status
*
Please Select
6
Complete
(Avlble in WD)
Complete
(avlble in letter)
Complete (in letter)
Pending
Status
If available please provide, otherwise provide indication of specific area of discovery (markup on drawing).
CAD Drawings - Status
*
Please Select
7
Complete
Pending
Status
We require survey of the location of the discovered utility, to be provided to the CAD team who will include on the CAD drawing.
Submit
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