Town of Derry
“Derry, New Hampshire’s Place to Be”
UTILITY LICENSED CONTRACTOR APPLICATION
The Town of Derry requires that all contractors who propose to perform work on municipal water or sewer utilities in the Town of Derry must be Prequalified by the Department of Public Works. There will be nine (9) classes of pre-qualification.
They are:
I. Water Main ( >4”) Installation
II. Water Service ( < 2”) Installation
III. Water Main Tapping > 4”
IV. Water Main Tapping < 2”
V. Sewer Main Construction include SMH
Installations and Corings
VI. Sewer Service Installations (6” – 8”)
VII. Sewer Main Taps and Coring
VIII. Excavation and Trench only
IX. Pump Station Construction/ Installation
(Service Grinder and Booster Pumps)
Each contractor who wishes to be prequalified must fill out the enclosed application including the classes for which they desire prequalification.. A contractor must demonstrate complete competence and aptitude in construction practices through references from other Municipal officials or Engineers. A minimum of 3 references for each class of certification must be submitted.
A General Contractor who utilizes subcontractors for either excavations, tapping or pipe laying may be Prequalified in the respective classes by submitting the subcontractor's name and references.
Be aware that the prequalifications shall specify a “responsible person” who shall be on site for all work to be performed by the contractor. A contractor may designate more than one “responsible person” on his application, however each “responsible person” must have valid references.
All contractors who are Prequalified must have a current original Street Opening maintenance bond in the amount of $5,000.00 or other acceptable surety and appropriate insurance certificates. The Town reserves the rights to increase bonding requirements for multiple or large scale utility projects up to 100% of the job cost.
Contractors must sign a statement certifying that they have obtained, read and understand all Town of Derry specifications for Utility construction.
Prequalifications are valid for as long as the responsible persons are employed by the Contractor and the bond is in place and the Contractor remains in good standing with the Town (all asbuilts are submitted etc.)
If there are any questions on the prequalifications process, requirements or questions relative to Derry’s construction specifications please contact Mark L’Heureux, Engineering Coordinator.
Please allow up to 10 working days to obtain prequalifications.
Town of Derry
“Derry, New Hampshire’s Place to Be”
Town of Derry, New Hampshire Utility Contractor
Application for Pre-qualification
I. Company Name: ______________________________________________
_______________________________________________
Principle Office Address
________________________________________________
Telephone: ___________________ Fax: ________________________
Classification: Check the appropriate classification for which pre-qualification is requested. A “responsible person” and three (3) references are required for each class.
_____ I. Water Main ( > 4” ) Installation
_____ II. Water Service ( < 2” ) Installation
_____ III. Water Main Tapping > 4”
_____ IV. Water Service Tapping < 2”
_____ V. Sewer Main Construction including SMH Installations
_____ VI. Sewer Service Installations (6” – 8”)
_____ VII. Sewer Main Taps and Coring
_____ VIII. Excavations and Trenching
_____ IX. Pump Station Construction/ Installation
(Service grinder and booster pumps)
Please complete a Responsible person/ reference form for each classification for which pre-qualification is requested.
Please provide a $5,000.00 Original Street Opening Maintenance Bond and a copy of the Contractor’s Insurance Certificates showing adequate public liability, property damage insurance and vehicle liability insurance coverage.
Town of Derry
“Derry, New Hampshire’s Place to Be”
Certification No._________
Responsible Person / Reference
Form
Utility Contractor Name: _________________________________________________
Classification: ___________________________________________________________
____________________________________________________________
Responsible Person * ____________________________________________________
Title: _____________________________________________________
Company: ______________________________________________________
References:
1. Project: __________________________________________________
Contact Person/Company: __________________________________
____________________________________
Telephone: _____________________ Fax: ______________________
2. Project: __________________________________________________
Contact Person/Company: __________________________________
____________________________________
Telephone: _____________________ Fax: ______________________
3. Project: __________________________________________________
Contact Person/Company: __________________________________
____________________________________
Telephone: _____________________ Fax: ______________________
I ______________________________ at ________________________________ have
Name Company Name
obtained, read and understood the Town of Derry’s Utility Construction Specifications and conveyed this information to the responsible person named above and agree that the responsible person shall be present during any construction of utilities, specifically (See classification description) ____________________________________________, for
Class
which my company has been hired as a Utility Contractor.
_________________________________________ ________________
Signature Date
Approved by:
__________________________________________ _________________
Town of Derry Date
Bond in the Amount of $ __________ has been received. Expiration Date____________
Attach Insurance Certificates.
/lfp