Fillable Massachusetts Department of Transport Request for Additional Class of Work

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Massachusetts Department of Transport Request for Additional Class of Work

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The Massachusetts Department of Transport Request for Additional Class of Work form is 4 pages long and contains:

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  • 46 check-boxes
  • 99 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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_____________________________________ _____________________________________________
Request for Additional Class of Work
Submit three completed projects for each selected class of work
Date: _______________________________
Name of Company: _____________________________________________________________________
Address: ______________________________________________________________________________
City: ________________________________State: _________________________Zip: ________________
Contact Person: ___________________________________________Vendor Code:___________________
Phone Number: ____________________________ E-mail Address:______________________________
Original Signature and Title Date Print Name and Title
Select Class of Work
Bridge – Construction Highway – Bike Paths Salt Marsh and Wetland
Restoration
Bridge – Culverts Highway-Construction Sewer and Water
Bridge – Deck Repairs Highway-Lighting Signing – Non Structural
Bridge – Joints Highway – Sidewalk and Curbing Signing – Structural
Catch Basin Cleaning Impact Attenuators Street Sweeping
Chemical Storage Sheds Intelligent Transportation Systems Traffic Signals
Crack Sealing Landscaping Including Tree
Planting
Tree Trimming -
Maintenance and Removal
Dam Construction Marine Construction Waterways
Demolition Mowing and Spraying
Drainage Painting–Structural
Drawbridge Maintenance Pavement Markings
Dredging Pavement–Milling and Cold
Planing
Drilling & Boring Pavement - Reclamation
Electrical –All Types–
Including Electrical Maintenance
Pavement - Surfacing
Guard Rail & Fencing Pump Stations
Hazardous Waste Remediation
&Transportation
Recreational Facilities
FOR OFFICIAL USE ONLY
Approved___________ Denied__________
Comments:__________________________
Email to: prequal.r109@dot.state.ma.us
Phone:
857-368-8660
____________________________________
1
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signature
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Request for Additional Class of Work
You may duplicate this template as needed
Submit three completed projects for each selected class of work
Please provide a detailed scope of work for each project. Projects listed should be $50K and over.
Do not list contracts completed more than 10 years ago.
1. Class of work:
1a. Other Classes of work performed: Dollar Value:
Project Title:
Location:
Owner:
Owner’s rep:
Telephone#: Email:
Architect / Engineer:
A/ E contact person:
Telephone#: Email:
Original contract amount: $ Original completion date:
Final contract amount: $ Final completion date:
Were you the Prime Contractor or Subcontractor for this project?
Percentage of work completed with own forces:
Value of work completed with own forces: $
Detailed Scope of Work:
Email to: prequal.r109@dot.state.ma.us Phone: 857-368-8660
MASSDOT, Highway Division
Prequalification Department
10 Park Plaza, Room 6260, Boston, MA 02116
2
Dollar Value:
Select from drop down menu...
Request for Additional Class of Work
You may duplicate this template as needed
Submit three completed projects for each selected class of work
Please provide a detailed scope of work for each project. Projects listed should be $50K and over.
Do not list contracts completed more than 10 years ago.
1. Class of work:
1a. Other Classes of work performed: Dollar Value:
Project Title:
Location:
Owner:
Owner’s rep:
Telephone#: Email:
Architect / Engineer:
A/ E contact person:
Telephone#: Email:
Original contract amount: $ Original completion date:
Final contract amount: $ Final completion date:
Were you the Prime Contractor or Subcontractor for this project?
Percentage of work completed with own forces:
Value of work completed with own forces: $
Detailed Scope of Work:
Email to: prequal.r109@dot.state.ma.us Phone: 857-368-8660
MASSDOT, Highway Division
Prequalification Department
10 Park Plaza, Room 6260, Boston, MA 02116
3
Dollar Value:
Select from drop down menu...
Request for Additional Class of Work
You may duplicate this template as needed
Submit three completed projects for each selected class of work
Please provide a detailed scope of work for each project. Projects listed should be $50K and over.
Do not list contracts completed more than 10 years ago.
1. Class of work:
1a. Other Classes of work performed: Dollar Value:
Project Title:
Location:
Owner:
Owner’s rep:
Telephone#: Email:
Architect / Engineer:
A/ E contact person:
Telephone#: Email:
Original contract amount: $ Original completion date:
Final contract amount: $ Final completion date:
Were you the Prime Contractor or Subcontractor for this project?
Percentage of work completed with own forces:
Value of work completed with own forces: $
Detailed Scope of Work:
Email to: prequal.r109@dot.state.ma.us Phone: 857-368-8660
MASSDOT, Highway Division
Prequalification Department
10 Park Plaza, Room 6260, Boston, MA 02116
4
Dollar Value:
Select from drop down menu...
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Massachusetts Department of Transport Request for Additional Class of Work

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Completed 16 May 2020

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