Form Center

2. Name
3. Email Address
5. Phone Number
7. Problem Location (nearest address)
9. City
10. State
11. Zip Code
13. Street Issue
    -- Select One --PotholeDead AnimalDamaged Street SignTraffic SignalLight OutFloodingSpeedingSidewalkTrashTrees
14. Water Issue
    -- Select One --Water QualityWater WasteWater LeakWater BillPressureValve LidMeter Box
15. Sewer Issue
    -- Select One --Sewer OverflowPlugged SewerSewer BillUtility Lid
16. Storm Water Issue
    -- Select One --FloodingDamaged PipePlugged InletPollutionTrash
18. Parks
    -- Select One --Damaged play equipmentOther unsafe conditionBathroom IssueFlooded areaGraffitiTrashLight OutTrees
20. Other issue please provide additional information (i.e, when you noticed the problem, how severe it is, etc):
22. Emergency

    These requests will be checked on the next business day. If this is an emergency please contact Cotati Police at 707-792-4611. 

Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field