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2. If a City employee went above and beyond to assist you, please complete this nomination on their behalf. Thank you.

4. Date & Time of Occurrence
   Date & Time of Occurrence

   Date & Time of Occurrence
6. Name of City Employee*
8. Explain Reason for Nomination
10. Your Name
12. Your Phone Number
13. Your Email Address
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15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

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