Certified Pesticide Applicator Licensing Form Summary

This is a Certified Pesticide Applicator Licensing Form required for bid submission to the Pennsylvania Department of Transportation (PennDOT) for the On Call Vegetation contract in Engineering District 12-0. The form serves as a qualification and compliance document for contractors bidding on vegetation management services, including general cleanup, herbicide application, mowing, landscape installation, and vegetation maintenance at various facilities and state route areas across Fayette, Greene, Washington, and Westmoreland counties. Contractors must complete and upload the form with all applicant information to avoid bid rejection.

The form requires contractors to list up to ten certified pesticide applicators, providing each applicant's full name as it appears on their license, certification number, business license number, category(ies) of certification, and license expiration date. Each applicator's license must be endorsed by the contractor's business license number. Failure to complete and submit this form with all required information will result in the bid being deemed non-responsive. This requirement applies specifically to the PennDOT small business procurement, which restricts eligibility to DGS-certified small businesses competing under the Small Business Procurement Initiative established by Executive Order 2011-09.