Water utilities across the United States are facing numerous challenges, such as limited funding and increasing project complexity, in constructing and upgrading their aging infrastructure. One innovative method to overcome these challenges is through the use of alternative project delivery methods (APDM), such as construction management at-risk (CMAR) and design-build (DB). Previous research has shown that APDM have the potential to deliver higher performing water infrastructure projects when compared to the traditional design-bid-build (DBB) method. However, there is a need to further examine APDM practices and develop tools that may support utilities in the delivery of their APDM water infrastructure projects. This study fills the knowledge gap by conducting several studies that may support public and private utilities in improving the delivery of their APDM water infrastructure projects. First, APDM implementation practices for water infrastructure projects are identified by assessing the state of practice, particularly during project procurement and execution. Second, DB project administration best practices are determined to support utilities seeking to add DB to their organization’s project delivery toolbox. Third, a pioneering web-based project delivery method decision-support tool was developed to aid utilities in selecting the appropriate delivery method for their water project. Finally, project-specific factors and attributes that impact project delivery performance are investigated through exploratory modeling and analysis. The study collected data on 75 completed treatment plant projects, conducted interviews with ten utilities that successfully deliver their water projects using DB, and worked closely with several industry experts through industry workshops and panels. Key findings related to water infrastructure project delivery revealed in this study included: (1) guaranteed maximum price (GMP) is the preferred compensation type for APDM projects; (2) utilities statistically having the lowest comfort level with delivering CMAR projects; (3) qualifications-based procurement is an effective DB project delivery practice; (4) the identification of 13 key project delivery method selection factors; and (5) the three highest predictors that impact unit cost performance are project complexity, project team chemistry and communication, and project size.