Attachment 4 - Certification of Conformance.pdf

USDA- NRCS

John L Clouse - WRE

CERTIFICATION OF CONFORMANCE

The undersigned primary contractor/supplier has furnished to:

Landowner’s Name: __________________________________________________________

Address: ________________________________________________________________

City/State/Zip: ___________________________________________________________

Practice (Name & Tech Guide Code): _________________________________________ and hereby states that the quality of work and materials meets the requirements as set forth on designs and specifications provided by the Natural Resources Conservation Service.

Name of Contractor/Supplier: _______________________________________________

Signature/Title/Date: ______________________________________________________

Description of work completed:

In addition, the landowner and/or the following subcontractors were also involved in the installation and they hereby certify their work meets the requirements set forth on designs and specifications as previously stated.

Landowner Signature/Date: ____________________________________________________

Description of items completed:

Subcontractor Signature/Date: _______________________________________________

Description of items completed:

Received by: ____________________________________________________________ (signature) (title) (date)

Note: It is the primary contractor/supplier’s responsibility to obtain and furnish all required signatures.