Report A Concern

2. Please complete the online form below to submit your complaint. PLEASE NOTE: Do not use this form to report an emergency or potentially life-threatening situation - call 911 immediately!

4. Contact Information

6. First Name*

7. Last Name*

9. Address1*

11. Address2

13. City*

14. State*

15. Zip

17. Home Phone Number*

18. Cell Phone Number

20. Daytime Phone Number

21. Email Address*

25. Information About Your Concern

27. Concern Type*
    -- Select One --Damaged Parking MeterPotholeStreetlight OutageWebsite FeedbackOther Issue

29. Closest Address*

30. Pole Number

32. Closest Address*

33. Meter Number

35. Closest Address

36. Location of Pothole*

38. Describe Issue*

40. Upload Photo

41. Additional Information

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field