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UH-20260511-0L7C

#1155 - Prior Lake · 05/11/2026 at 2:30 PM · 15923 Island View Rd

OpenTelephoneAt fault: Yes

Claim statusOpenRequestedNot recordedSettledNot settledOffice sign-in to update

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1

Job & timing

Job number: #1155 - Prior Lake
Date of damage: 05/11/2026
Time of damage: 2:30 PM
Form filled out: 09/08/2026
Submitted: 09/08/2026 5:22 PM
Person filling out form: Beth Tatge
Foreman on the job: Barry Sampson

2

Office notification

Date office notified: 05/11/2026
Method of notification: Cell
Who was contacted: Mike Holasek

3

Utilities hit

Location of utility hit: 15923 Island View Rd

TelephoneNuvera

Utility type: Telephone
Utility company: Nuvera
Utility notified: Yes
Company arrived onsite: Yes
GSOC #: —
Most recent locate: —
How it was marked: Paint, Flag
Marks accurate or off: No

4

What happened

Summary of incident: Messy boulevard, didn't realize it was there. Should have had it remarked
Are we at fault?: Yes
Why?: Should have had it remarked.
Utility said we are NOT responsible?: No

5

Pictures (4)

4 taken by Beth Tatge

Incident photo 1 — DownloadPhoto 1 — uploaded 09/08/2026 5:22 PM · camera file dated 03/29/2023 9:17 AM

Incident photo 2 — DownloadPhoto 2 — uploaded 09/08/2026 5:22 PM · camera file dated 03/29/2023 9:17 AM

Incident photo 3 — DownloadPhoto 3 — uploaded 09/08/2026 5:22 PM · camera file dated 03/29/2023 9:17 AM

Incident photo 4 — DownloadPhoto 4 — uploaded 09/08/2026 5:22 PM · camera file dated 03/29/2023 9:17 AM

6

Signature

Signature

Signed by Beth Tatge on 09/08/2026

7

Claim history

Every status change, newest first.

Open09/08/2026 5:22 PM · Beth Tatge
Report filed from the field.