CONTRACTOR REGISTRATION QUESTIONNAIRE
1. Name, address, PA Contractor License / Registration # and form of organization (sole proprietorship, partnership, corporation, etc.).
2. Years the organization has been in business as a contractor under its present name.
3. Name, phone numbers and email addresses of managing individuals.
4. List at least 3 municipalities where you have completed Sanitary Sewer / Water projects in Pennsylvania within the last 5-years. Identify the nature of the project and the contract amount.
5. Portion of the work for projects in the WBRA service area that Registrant expects to perform using its own labor and equipment.
6. Subcontractors must also be registered with WBRA. List any Subcontractors that will be working with / for you. NOTE: You must notify your Subcontractor(s) to register with WBRA.
7. List any judgments against the firm within the last 10-years.
8. Please attach proof of Liability Insurance for a minimum of $100,000 and return it to Bob Kaiser at WBRA located at 127 Girton Dr. Muncy, PA 17756, or . NOTE: Proof of Liability Insurance must be provided to WBRA every year for the contractor to remain eligible.
All sewer/water installations must meet West Branch Regional Authority standards and must be inspected by a WBRA inspector before they are covered. Contractors must obtain a permit and be registered with WBRA, and are required to use the Authority’s Standard Detail Drawings for construction reference. Contractors must notify WBRA a minimum of 24 hours prior to the start of any sewer/water project. For work to be started on a Monday morning, notice must be provided on the preceding Friday morning at the latest. WBRA reserves the right to require that any installation work performed without WBRA inspection due to inadequate notice, be uncovered for inspection.
Customers, contractors or developers who need to schedule an inspection or re-inspection should contact Dan Whitmoyer at (570) 560-2023. There is no charge for the first inspection; however, WBRA reserves the right to charge for subsequent inspections that result from failed tests or improper installation, etc. so please plan accordingly.
Note: Contractors must not proceed with repairs where a property owner may be eligible for Government Grant Assistance until WBRA approval has been given. All grant procedures must be followed in order to maintain the property owner’s grant eligibility.
· If work is to be done in the street or alley, an excavation and / or pavement disturbance permit may be required from the Municipality – this permit must be obtained prior to construction and be available onsite for inspector’s review.
· Contractors must follow all existing federal, state, and local safety regulations, including completing a PA One-Call ticket @ 1-800-242-1776.
· New laterals should be installed a minimum of 10-feet from existing trees and must be no less than 1-foot from property lines.
· Saddles are not permitted for connecting to the sewer main.
· Connections to lined sewer mains require specific fittings and adhesive – see inspector for details if this type of connection is anticipated.
· Connections into a manhole are not allowed except in special cases as determined by WBRA. If a special case is approved, a standard detail will be provided with construction requirements.
· If needed, all fernco fittings must be “strong back” type when possible.
· An air test must be performed by the contractor and witnessed by the WBRA inspector at final inspection.
CONTRACTOR’S VERIFICATION
I ______the undersigned, hereby state that I have read and understand the above requirements, that I am authorized to make the statements set forth above and verify that said statements are true and correct to the best of my knowledge, information and belief. The undersigned understands that the statements therein are made subject to the penalties of 18-PA.C.S., Section 494 relating to unsworn falsification to authorities.
______
Date Signature
Registration Questionnaire (February 2016)
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