Town of Ocean City, Maryland
Utility Installation Agreement (UA)
Project Summary Form
Page 1 of 1 Updated: August 17, 2018
UTILITY INSTALLATION AGREEMENT (UA)
for PRIVATE UTILITIES in RIGHT-OF-WAYS & PUBLIC EASEMENTS UA #
http://oceancitymd.gov/ua
(Completed by Utility Owner’s Authorized Representative)
DATE: __________________________________________________
UTILITY OWNER: __________________________________________________
ADDRESS: __________________________________________________
__________________________________________________
GENERAL CONTRACTOR: __________________________________________________
ADDRESS: __________________________________________________
__________________________________________________
AUTHORIZED REPRESENTATIVE: __________________________________________________
EMAIL: __________________________________________________
PHONE #: __________________________________________________
ADDRESS: __________________________________________________
__________________________________________________
PROJECT LOCATION(S): __________________________________________________
UTILITY TO BE INSTALLED: __________________________________________________
UTILITY INORMATION: MATERIAL: __________ SIZE:________ LENGTH: _________
INSTALLATION METHOD: Open Cut Horizontal Directional Drill (HDD)
MISS UTIL. TICKET #. (if avail.): __________________________________________________
PROPOSED START / END DATE: __________________________________________________
PROJECT DURATION: __________________________________________________
(Completed by Ocean City Engineering + Public Works)
Engineering Approval:
________________________
(Terry McGean, City Engineer)
UA (all 6 pages + Cover Page): ___________
Approved Project Plans: ___________
Project Schedule (if > 2 weeks): ___________
Performance & Maintenance Bond: ___________
Certificate of Liability Insurance: ___________
Permit Fee Amt. (Res. No. 2017-16): ___________
Traffic Control Plan: ___________
Boardwalk Vehicle Access: ___________
SHA Approval Required: ___________
UA Expiration Date: ___________
Public Works Approval:
________________________
(Elwood Vickers, PW Deputy Director)
Pre-Construction Meeting: _____________
Miss Utility Ticket No.: _____________
Test Pitting Ex. Utilities: _____________
Photos in S: Drive Folder: _____________
Pavement Restoration: _____________
Concrete Restoration: _____________
Paint & Striping Restoration: _____________
Construction Debris Removed: _____________
As-Built Drawings Received: _____________
Permit Fee Paid: _____________
Final Completion Date: _____________
