Private Utility Locate Customer Authorization Form

Customer authorization and scope-of-work form for private utility locate services not covered by 811, including site access, deliverable expectations, and limitation of liability.

Requestor Information

• Requestor Name
• Company or Organization
• Email Address
• Phone Number

Site and Project Details

• Site Address
• City, State, and ZIP
• Project Description
  Briefly describe the planned work and why a private locate is needed.
• Requested Service Date

Utilities and Scope of Work

• Utility Types to Locate
• Other Utility Type
• Locate Scope
• Scope Details

Site Access and Deliverables

• Site Access Method
• Access Instructions
• Deliverable Expectations
• Special Instructions

Authorization and Acknowledgement

• I authorize the requested private utility locate service at the site listed above.
• I understand this is a private utility locate service and is not a substitute for 811 public utility marking.
• I acknowledge that locate results are based on available records, visible indicators, and field conditions, and that hidden or unmarked utilities may exist.
• Authorized Signature
• Signature Date