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NIANAGEMENT
*****NOTICE OF CLAIM*****
Date: 04-21-2010
CERTIFIED MAILLRETURN RECEIPT REQUESTED
To: WELD COUNTY
COUNTY COMMISSIONERS
P.O. BOX 758
915 TENTH STREET
GREELEY, CO 80632
CERTIFIED MAIL# 91 7108 2133 3935 8313 6376
RE: Damage to Qwest Property
Qwest Claim Num: 488717
Damage/Discovery Date: 04-19-2010
Damage Location: 6154 CR 80,WINDSOR,CO
Damage County:
Damage Amount: UNDETERMINED
Dear Sir/Madam:
Please be advised that Qwest Facilities sustained damage as a result of the negligent acts or
omissions by employees or agents of WELD COUNTY .
Investigation has revealed that on or about 04-19-2010 employees or agents of WELD COUNTY,
WELD COUNTY PUBLIC WORKS DAMAGED A QWEST BURIED SERVICE WIRE WITH A
GRADER DURING HIGHWAY/STREET EXCAVATION in the area of 6154 CR 80, WINDSOR ,
CO.
REQUEST FOR GOVERNMENTAL NOTICE FORM
If your Governmental Entity requires the completion of its own form to complete proper notice, please
forward a copy to the address listed above. Every good faith effort has been made to identify the proper office
and address to perfect our notice. Please forward to your attorney, if misdirected, to contact us. Matters
herein stated are alleged on information and belief this pleader believes to be true. If there is insurance to
cover this matter, kindly advise as to the name of the insurance company, its address and the claim number
assigned. If you have any questions, or need additional information, please contact me at 1-800-321-4158 ext
8226. %\""tiE 4p4q Gb pi
Sincerely, is #06011483
Destiny Wilson E EXP. 1128/10
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