A00808-610535.pdf

Massachusetts Department Of Transportation Highway Division Proposal No. 610535-134928

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DOCUMENT A00808

Project Utiltity Cordination Form

Massachusetts Department Of Transportation Highway Division

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Revision

Date:

M ass DO

T PM

Total Poles Relocated:

4/2/2026

PRIN

TED

Yes N o Agreem ent

YES

N O

YES

N

O

UG

O H

Eversource G as

Jeffrey Evans-M ongeon

508-305-6970 Jeffrey.Evans-M ongeon@ eversource.com

X X

X X

W orcester DPW

W ater M ike Daigneault 508-929-1300 ext.

Daigneaultm ci.w orcester.m a.us

N /A

N /A

X X

X

Suggested Sequence of Relocation (Based on Consultant proposed construction staging) The sequence as detailed on the follow ing pages is based on the consultants proposed staging plan. This inform ation w as com piled through m eetings that included all of the utilities listed below along w ith the designer and the City of W orcester. The inform ation provided is the best available inform ation prior to project advertisem ent.

U tility Relocation N otes for M assDO

T Contractor Unless otherw ise noted by Contract, the M assDO

T Contractor is to provide the District Construction O ffice w ith 7 Calendar Days advance notification in order to validate the current progress and provide the required 30 Days advance notice-to-proceed for the first Utility - and each subsequent Utility. These advance notifications are to be identified in the Contractor's Schedules (Pre-Con preparation, Baseline, Subnets, and Updated/M onthly Schedules) as specified in Subsection 8.02 (for DBB Contracts) and/or Section 9 (of DB Contracts). N ote: The durations included below do not include these lead-tim

es. See Additional 'Im portant Basis notes for Contractor' - on last PUC Form page.

Additional notes:

U tilities

U nderground (U

G

/Aerial (O H)

Route/Street:

Toole Design Coleen Lautrup

857-398-6511

Scope, Budget, Duration Subm itted Reim bursem ent

U tility Com pany Contact

O ffice #

Cell # Em ail

N on-Reim b'le N otes

Potential for District Initiated Early Relocation *

U tilities O n Bridge/Structure

Pleasant Street

TBD

Adetoyin O laoye

Consultant:

Contact:

O ffice #

Cell # Em ail clautrup@ tooledesign.com

W orcester

610535 R. Goodale

N ational Grid

City/Tow n:

PU

C Com pleted by:

Project File #:

U tility Pole Set:

CO

N

TACTS AN

D GEN

ERAL UTILITY IN

FO

RM

ATIO

N

Project U tilities Coordination (PU

C) Form

Resident Engineer:

Scheduled Ad Date:

Betterm ent W ork X

6/27/2026

Proposal No. 610535-134928

A00808 - 3 mailto:clautrup@tooledesign.com mailto:clautrup@tooledesign.com mailto:clautrup@tooledesign.com mailto:clautrup@tooledesign.com

Yes N o 4/2/2026

X

PRIN

TED

Yes N o

X

Exclusive U tility on site

Concurrent U tilities

Contractor O ff-Site Contractor Concurrent

C = Contractor U = Utility Co.

Utility working with no other

Utilities in vicinity

Utility working with other Utilities on site

No Contractor physical construction operations on-site

(while Utility is Contractor and

Utility are working on-site - but NOT in the same vicinity

C

Task: 4 U

X X

N o

U X

X N o U

X X

N o

U X

X N o U

X X

N o

U X

X N o U

X X

N o

U X

X N o U

X X

N o

U

X X

N o

123456789

M obilize &

M aterials Delivery and Project Planning

1020342015

Sub-Total

U nless otherw ise specified in the M assDO

T Construction Contract, or unless specifically noted w ithin this PU

C Form , these durations (herein) are based upon the Contractor providing unim peded access to the U tility com pany to perform

U tility relocations (see N ote 5 - Access).

Access - U nless otherw ise noted in the Contract, and in addition to the 'enabling' notes above, the Contractor m ust provide safe and unim peded access (for trucks, lifts, cranes, etc.) to the U tilities, to allow for the proposed relocation(s) -including but not lim ited to snow rem oval, clearing and grubbing, guard rail rem oval, barrier rem oval, tree rem oval, and grading. Any costs associated w ith these tasks are deem ed to be incidental to the project.

For all M assDO

T construction contracts issued after January 2014, the new U tility Coordination/docum entation specification is required. This is Section 8.14 in Design-Bid-Build Contracts (see Design-Build index reference for applicable section #).

Prior to starting any and all enabling w ork for U tilities, the Contractor is to plan in advance w ith subm ittals and approved durations.

* Potential District Initiated Early U tility Relocation - if noted herein, the District reserves the right to initiate early utility relocation in advance of the Contract N

TP. In subm itting a bid price and in the developm ent/basis of the Baseline Schedule, the Contractor shall not plan the W ork w ith the potential benefit of any form of 'early utility relocation.' As a requirem ent of the Baseline subm ission, unless otherw ise noted in this Specification, the earliest that the first U tility com pany is to receive the 30 days advance notification to m obilize to the site, w ill be 7 calendar days after the pre-construction m eeting and never sooner than 7 days after the Contract N

TP.

"Concurrent U tilities" operations noted herein, are to signify those U tility Com pany operations that can be w orked concurrently (e.g. U tility A and U tility B w ork on-site together) - M assDO T and the Contractor are to prepare N

TPs to U tilities accordingly.

RESPONSIBLE PARTY

Concurrent / Exclusive U tility W ork Contractor note: In planning and executing the w ork, the Access Restraints listed in the Special Provisions, takes precedence over the checklist in these 4 colum ns.

DESCRIPTIO

N

- U tility Relocation Phases, Tasks and Activities

Potential Access Restraint (Yes/No)

Eversource G as

U

TILITY O

PERATIO

N

S - U nderground

Enabling' w ork by the Contractor - Coordinate w ith Eversource during betterm ent w ork installation.

Is 'enabling' (prep) w ork, by the Contractor, necessary prior to the start of the first series of utility relocations:

Has any of the U tility w ork been identified to w ork concurrently

PU

C FO

RM

- CO

N

TIN

U

ED

Reason/Note (optional)

Access Restraint & Lim itations of O perations N otes

Should an AR be considered for the Contractor ?

Estimated Duration (Work Days) by Utilities (Lead time not included)

"Potential Access Restraints" noted w ithin this PU

C Form are for planning purposes. See M assDO T Contract for Contractual Access Restraints (refer to Subsections 8.02, 8.03, and/or 8.06 for Design Bid Build Contracts and Volum e II Section 9 for Design Build Contracts).

U tility non-w ork periods - For planning purposes, the durations above contain som e non w ork days (contingency) for N ew

England conditions (precipitation, high tem peratures, low tem peratures, snow

, ice). Gas line w ork how ever, typically has a seasonal restriction and can N

O T be installed from

15-N ovem ber to 15-M arch. M unicipally O w ned Electric and Gas U tilities are also restricted from proceeding from 15-N ovem ber to 15-M arch. The Contractor shall (and the CTD plan) reflect this calendar restriction w ithin the schedule (unless otherw ise note).

IM

PO

RTAN

T BASIS N

O

TES - FO

R CO

N

TRACTO

R

Install 2" IP HDPE Gas M ain in project scope bounds on Pleasant St (Side Street Stubs)

Install 4" IP HDPE Gas M ain in project scope bounds on Pleasant St (2,735') STA. 16+69.82 to STA 43+75

Install 8" IP HDPE Gas M ain in project scope bounds on Pleasant St (1,080') STA 44+10 to STA 53+ 20.5

Install 4" IP HDPE Gas M ain in project scope bounds on Pleasant St (2,745') STA 53+25 to STA 80+70

Service relays & tie-overs (13 Relays, 36 Tie overs)

Backfill & Site restoration and dem obilize

Pressure Test and nitrogen purge m ain into service

Abandon / Retire old 4", 6", 8" CI, CS, BS Gas M ain

Pig new m ain

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