Traffic Concern Reporting Form

2. What is the Traffic Concern?*
   -- Select One --Speeding (5 to 10 MPH above limit)Speeding (15 to 20 MPH above limit)Speeding (over 20 MPH above limit)Running Stop SignsRunning Red LightsOther (please type below)

   Please select from the drop down menu or provide a response below if your concern is not included on the list.
4. Other Concern (not on the list above)
6. Area/ Location of Concern*
   Please provide the crossroads and/or address where the traffic concern is occurring.
8. When Does the Traffic Concern Happen?*
   Please provide the time span when the issue typically occurs (i.e. peak hours)
12. Name*
13. Email Address
15. Address
17. City
18. State
19. Zip Code
21. Phone Number*
22. Fax Number
24. Public Records Disclosure: Florida has very broad public records laws. Most written communications to or from local officials regarding official business are public records available to the public and media upon request. Your e-mail may therefore be subject to public disclosure, if requested.
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field