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UH-20261006-SSCC

#1160 - Willmar · 10/06/2026 at 4:28 AM · 402 Kandiyohi

OpenGasAt fault: Yes

Claim statusOpenRequestedNot recordedSettledNot settledOffice sign-in to update

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1

Job & timing

Job number: #1160 - Willmar
Date of damage: 10/06/2026
Time of damage: 4:28 AM
Form filled out: 10/07/2026
Submitted: 10/07/2026 7:27 AM
Person filling out form: Barry Sampson
Foreman on the job: Barry Sampson

2

Office notification

Date office notified: 10/06/2026
Method of notification: Cell
Who was contacted: Orry Wiechman

3

Utilities hit

Location of utility hit: 402 Kandiyohi

GasCenterpoint

Utility type: Gas
Utility company: Centerpoint
Utility notified: Yes
Company arrived onsite: Yes
GSOC #: 261800801
Most recent locate: 09/29/2026
How it was marked: Paint
Marks accurate or off: Accurate

4

What happened

Summary of incident: After removing the grass and concrete. The guys completely forgot that the gas service was there.
Are we at fault?: Yes
Why?: There was one faint mark after removing grass and sidewalk. The guys just forgot about it
Utility said we are NOT responsible?: No

5

Pictures (5)

5 taken by Barry

Incident photo 1 — DownloadPhoto 1 — uploaded 10/07/2026 7:27 AM · camera file dated 10/06/2026 9:45 AM

Incident photo 2 — DownloadPhoto 2 — uploaded 10/07/2026 7:27 AM · camera file dated 10/06/2026 9:46 AM

Incident photo 3 — DownloadPhoto 3 — uploaded 10/07/2026 7:27 AM · camera file dated 10/06/2026 9:46 AM

Incident photo 4 — DownloadPhoto 4 — uploaded 10/07/2026 7:27 AM · camera file dated 10/06/2026 9:47 AM

Incident photo 5 — DownloadPhoto 5 — uploaded 10/07/2026 7:27 AM · camera file dated 10/06/2026 9:47 AM

6

Signature

Signature

Signed by Barry Sampson on 10/07/2026

7

Claim history

Every status change, newest first.

Open10/07/2026 7:27 AM · Barry Sampson
Report filed from the field.