15-Attachment A-2 Request For Service Form.pdf
PDF 116 KB Posted
- Solicitation number
- OPN2132461B1
- Issued by
- Broward County, Florida
About this file
This is a Request for Service Form issued by the Broward County Public Works and Transportation Department, Water and Wastewater Services Division, specifically for coordinating maintenance and service activities on water mains, gravity sewer mains, lift stations, and force mains within Broward County, Florida. The form serves as the official mechanism for contractors to request access to county water and wastewater infrastructure for planned work activities. Contractors must submit completed forms to the Water and Wastewater Operations Division at 2555 West Copans Road, Pompano Beach, Florida, no less than 72 hours in advance of the requested service date and time, excluding weekends and holidays. Submissions must be hand-delivered by 9:00 a.m. and must include detailed drawings, location maps, activity descriptions, schedules indicating time and sequence of events, manpower requirements, and materials to be used. The form requires contractor information, project details, exact service location, approximate service duration, and the number of customers potentially affected by the work.
The form must be completed in its entirety with particular attention to the type of service requested and detailed activity descriptions. Upon delivery, contractors receive a time-stamped copy, and the Water and Wastewater Engineering Division's Chief Inspector receives a copy after approval by the Water and Wastewater Operations Division. Contractors are responsible for notifying the Inspection Section at 954-831-0901 prior to the requested service date, and requests will not be honored unless an inspector or engineer is present during the service work. The form indicates whether the request is approved or denied, with reasons for denial provided if applicable. This form is directly related to the FEMA Pipe and Valve Maintenance & Installation Services contract opportunity, which establishes an open-end contract for supplying FEMA-compliant pipe and valve maintenance and installation services to Water and Wastewater Services and other Broward County agencies.
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Text version
Broward County Public Works and Transportation Department
Water and Wastewater Services
WATER AND WASTEWATER OPERATIONS DIVISION
2555 West Copans Road, Pompano Beach, Florida 33069
PLACE
TIME AND DATE STAMP
HERE
REQUEST FOR SERVICE
Service information for water mains, gravity sewer mains, lift stations and force mains.
Contact Water and Wastewater Operations Division (WWOD) 2555 West Copans Rd., Pompano Beach, FL 33069. Phone: (954) 831-0810.
Project Number: Project Title:
Contractor Name:
Contractor Mailing Address: Zip Code:
Telephone No.: ( ) Fax No.: ( )
Requested By: Date:
Requested Date: Requested Time: (AM) (PM)
Type of Service Requested: (Attach detailed drawings and location map.)
Exact Street Address: City: Zip:
Approximate Length of Time for Service:
lf Shutdown, Approximate Number of Customers Affected:
Describe Activity in Detail: (Include copy of schedule indicating time and sequence of events, manpower, and materials used, etc.)
Inspection Authority: Phone No.: ( )
Engineer of Record: Phone No.: ( )
Request for Service WWOD contact and phone number for contractor’s specific request:
Name:___________________________________________ Number: _______________________
Request for Service Approved as Requested Above
Request for Service is denied as Requested Above
Reason Request for Service is denied:
• Alternative Date and Time Service can be provided:·
• Signed: Date:
Internal Form (Rev. 11/2013)
TO BE COMPLETED BY WWOD
TO BE COMPLETED BY CONTRACTOR REQUESTING SERVICE
• • • SEE REVERSE SIDE FOR PROCESSING AND ROUTING INSTRUCTIONS • • •
cbgarcia Typewritten Text
ATTACHMENT "A-2"
Contractor:
• Obtain form from Water and Wastewater Engineering Division (WWED), Inspection Section, or Operations Division.
• Complete every section of form, with special attention given to type of service requested, including a detailed description of activity.
• Submit completed form by 9:00 a.m., and no less than 72 hours in advance of requested date and time, excluding weekends and holidays.
• Hand deliver completed Request for Service to:
WATER AND WASTEWATER OPERATIONS DIVISION
2555 WEST COPANS ROAD, BLDG. 2
2nd Floor Lobby
POMPANO BEACH, FL 33069
PHONE: (954) 831-0810
• Faxed or emailed requests cannot be accepted.
• Contractor will receive a time/date copy of the request when it is delivered to 2nd floor lobby.
• WWED’s Chief Inspector will receive a copy of the request after the form is signed, approved, and completed by WWOD.
Contractor is responsible for notifying WWED Inspection Section at 954-831-0901 prior to requested service taking place.
Requests will not be honored unless inspector or engineer is present at time service is provided.
PROCESSING AND ROUTING INSTRUCTIONS
File details come from the government source that posted it. Updated .