\
The Cities of Iowa City and Coralville want to know about large cracks, potholes, quantities of broken glass, and other defects in roads and pavements that are of concern to bicyclists and motorists. To enable repairs to occur, please print out the form below and return it to any Iowa City bike shop. Thanks for your participation!
Location: [ ] Iowa City [ ] Coralville Roadway Name: _________________
Landmarks (cross street, number of feet from curb, address, etc.)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Description of problem: (What is it and why is it a problem?)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Reported by: (for BIC purposes only) Name ___________________________________
Address ___________________________ City ___________________________________
Date _____________ Day Phone _______________ Evening Phone _________________