116104420
Development Deed – Pre Construction
Verification Form
(To be lodged by the Consultant)
(Separate form to be used for Sewer or Water or Recycled Water)
(Must be submitted at least five (5) clear working days prior to commencement).
Email: developmentworks@yvw.com.au
Service:
Water Supply 
Fax: (03) 9872 1696
Recycled Water 
Sewerage 
Details of Development
Estate Name :
Location :
Yarra Valley Water Ref :
Case number: …………………………………
Project number: ………………………………
Engineering Services
Consultant :
Consultant Reference :
Consultant Nominated
Representative :
1
2
Documentation to be submitted (Please cross out where not applicable)
1.1
Consultants’ risk based audit schedule in accordance with Clause 7.8, Yarra
Valley Water’s Land Development Manual
1.2
Evidence that insurance policies are in accordance with Clause 11,
Development Deed Standard Conditions
1.3
Contractor’s Project Management Plan
1.4
Contractor’s Inspection & Test Plan
1.5
Copy of Council approval for Asset Locations
1.6
Verification Form Attachment Sheet, if any of the items on this form are not
applicable.
Information
Works Program
Commencement Date
/
/
Estimate Completion Date
/
/
Working Hours
June 2009
am
pm
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116104420
Key Personnel
Audit Services Consultant
Construction Auditor
Phone:
Contractor
Construction Supervisor
Phone:
Licensed Surveyor
Phone:
Sub- Contractors
3
Authorised Pipelayer
Phone:
Maintenance Hole Builder
Phone:
Approved Live Sewer Contractor
Phone:
Tapping Under Pressure –
Water Contractor
Phone:
Boring Contractor
Phone:
Disinfection Contractor
Phone:
Consultant’s Assurance
As the Consultant’s Nominated Representative responsible for the project
management of the works detailed in Yarra Valley Water’s Development Deed,
YVW Case No……….……………
YVW Project No……….……………
I verify that :
The project management of the works detailed in Yarra Valley Water’s
Development Deed will proceed in accordance with the lodged Project
Management Plan and Audit Schedule.
Consultant’s Nominated Representative
_______________________________
Name
_____________________________
Company Position
__________________________________
Signature
________________________________
Date
I agree to notify Yarra Valley Water within 24 hours of any changes to the information
certified above.
June 2009
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116104420
PRIVACY STATEMENT
Yarra Valley Water collects personal information for the purposes of providing water and sewer related services and
products, promoting such services and market research. We may disclose your personal information to our contractors
for these purposes and other third parties including Melbourne Water and the Minister for Environment and
Conservation relating to Parks Victoria services. You may request access to your personal information that we hold by
writing to the Privacy Officer at Private Bag 1, Mitcham VIC 3132. Please note we may charge you the reasonable cost
of providing you with access to your personal information.
Yarra Valley Water Limited, ABN 93 006 902 501, Lucknow Street, Mitcham 3132
Private Bag 1, Mitcham, Vic 3132
DX 13204 Mitcham
Telephone: 131 695
Facsimile: (03) 9872 2500
Email: enquiry@yvw.com.au
DX 13204 Mitcham
Web:
www.yvw.com.au
June 2009
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