Shawn Camp

1Project Details

2Crew

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Project Details

Project Name(Required)

Description of Work(Required)

Site(Required)

Carrier(Required)

Estimated Project Duration(Required)

Days/Weeks/Months(Required)

Requested Start Date(Required)

General Contractor(Required)

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Email(Required)

Point of Contact(Required)

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Sub Contractor 1

Phone

Point of Contact

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Sub Contractor 2

Phone

Point of Contact

First Last

Insurance and Construction Documents

General commercial liability coverage – minimum $1,000,000
Automobile liability coverage, all/owned/rented autos – minimum $1,000,000
Workers’ compensation coverage – minimum $500,000, covered for North Carolina
Umbrella coverage, – minimum $5,000,000

The City of Charlotte must be listed as an additional insured under the general commercial liability coverage.

Certificate holder, listed as follows:
City of Charlotte
Attention: Real Estate, Portfolio Management
600 E. 4th Street, CMGC 14th Floor
Charlotte, NC 28112

ALSO: CD (IF applicable) (Construction Drawing) SA If applicable (Structural Analysis) Structural mod If application

Construction Docs + Contractor Insurance Docs(Required)

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Accepted file types: jpg, gif, png, pdf, jpeg, doc, docx, Max. file size: 20 MB.

For Each Contractor Above

The following documentation is required before any access may be granted on any City-owned telecommunications sites and must be submitted to the City’s consultant, PRS, via this form.

Notices to Proceed (NTP) will be issued within 48 hours of verification of all required documentation. Issuance of NTPs will be delayed if the required information is incomplete.

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Safety Certifications and Identification for Site Access:

I Understand I Have To Upload 1 File Per Cert(Required)

Tower Work:
Please provide the following for
all Tower Crew members who will be on site
(Except for civil work – See Below):

OSHA certification – 30 hours, foremen; (1 person on each crew)
OSHA certification - 10 hours, all other workers (note: each tower climb requires one foreman)
Authorized climber and rescuer - certificates/cards for all climbers – Must be certified with a third party company under your company.
Competent climber and rescuer - certificate/card for at least 2 tower crew member - Must be certified with a third party company under your company.
Competent Rigger – One crew member must have this certificate
RF training certificates/cards (For all tower crew members) – third-party training program
Copy of a valid, current government-issued photo ID – For all crew members.
CPR/First Aid – For at least 2 crew members

Does This Job Require Foreman?(Required)

Yes

Foreman(Required)

First Name

Last Name

Foreman Docs(Required)

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Accepted file types: jpg, gif, png, pdf, jpeg, doc, docx, Max. file size: 20 MB.

OSHA Certification - 30 Hours

Does This Job Require Tower Climbers?(Required)

Yes

Tower Climbers(Required)

First Name

Last Name

Tower Climber Docs(Required)

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Accepted file types: jpg, gif, png, pdf, jpeg, doc, docx, Max. file size: 20 MB.

OSHA certification - 10 hours - Certificates/cards for all climbers – Must be certified with a third party company under your company.

Civil Work:
Please provide the following for
all Civil Crew members who will be on site

Copy of a valid, current government-issued photo ID, For all crew members
CPR/First Aid, For at least 2 crew members

Civil Crew

First Name

Last Name

Civil Crew Docs

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Accepted file types: jpg, gif, png, pdf, jpeg, doc, docx, Max. file size: 20 MB.

Integrators And Other Supervisory Personnel

First Name

Last Name

Role

Integrators And Other Supervisory Personnel Docs

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Accepted file types: jpg, gif, png, pdf, jpeg, doc, docx, Max. file size: 20 MB.

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