Title 105, Article 13, Rule 3, Section 1(a) of the Indiana Administrative Code requires Utility Companies to submit authorized representative information to INDOT for use during coordination for highway improvement projects. Use the form below to submit new representative information or to change your existing representative information. Please complete as many of the fields as possible. The fields with an asterisk located to the right side are required fields. All other fields are not required but the information will help INDOT populate our data table and may provide alternate means of communication that will help expedite coordination under specific circumstances. For a utility company that is privately or cooperatively owned, please provide an official name under which your company does business. The magnifying glass located to the right side of the utility name field connects you to the Secretary of State website that maintains a list of all official company names. Please select a name of your utility that is shown in the list. For utility companies that are owned by a municipality, please enter your utility company name in a format similar to one of these two entries, substituting the name of your municipality appropriately "Indianapolis, City of" or "Speedway, Town of". If your utility owns two different types of facilities (example – gas and electric) you will need to enter data and submit for each type of facility. If you have any specific question regarding the requested data entry, please contact Connie Kleyn-Siebenthal at 317-232-7573 or ckleyn-siebenthal@indot.in.gov.  The information requested is:
Utility Company Name: HyperLink  
Facility Type:  
Authorized Representative First Name:  
Authorized Representative Last Name:  
Authorized Representative Title:
Phone Number Office:    
Phone Number Mobile:
Authorized Representative Email:  
Phone Number Fax:    
Postal Delivery Address Line 1:
Postal Delivery Address Line 2:
Postal Delivery City:
Postal Delivery State:
Postal Delivery Zip Code:  
Parcel Delivery Address Line 1:  
Parcel Delivery Address Line 2:
Parcel Delivery City:  
Parcel Delivery State:
Parcel Delivery Zip Code:    
Comments:  
Name of Person Submitting Data for Utility:  
 
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