Pesticide Certification.pdf
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- Solicitation number
- RFB 605 2500000624 1
- Issued by
- Rowan County, Kentucky
About this file
This is a Pesticide Certification form issued by the State of Kentucky Department of Transportation for contractors performing pesticide-related work on state contracts. The certification requires contractors engaged in pesticide activities in pest management areas that could impact waters of the United States to acknowledge compliance with the KPDES Pesticide General Permit (KYG99) and the Pesticide Discharge Management Plan (PDMP). Contractors must read and understand the terms and conditions outlined in the PDMP before commencing work and certify their understanding under penalty of law. The form applies to herbicide, insecticide, and fertilizer applications and must be completed and signed by the contractor representative, including company information, address, contact details, type of pesticide service to be provided, and date of certification.
Violations of any conditions within the PDMP may result in substantial penalties or loss of contract for the contractor. The Kentucky Department of Transportation provides contractors with access to the complete PDMP documentation through a designated online link for review prior to signing the certification. This certification requirement ensures environmental compliance and protects waters of the United States from pesticide discharge impacts, with contractors responsible for communicating PDMP requirements to all employees working on the designated project.
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Text version
CONTRACTOR CERTIFICATION
Contract Number: _______________________________________
Contract Name: _________________________________________
Contractor Representative: ________________________________
As a contractor, you are required to comply with the KPDES Pesticide General Permit, KYG99, and the Pesticide Discharge Management Plan (PDMP) for any work that you perform for the above designated contract. Any person or group who violates any condition of the PDMP may be subject to substantial penalties or loss of contract. You are encouraged to advise each of your employees working on this project of the requirements of the PDMP. A copy of the PDMP is available for your review at the link below:
https://transportation.ky.gov/Maintenance/Documents/Pesticide%20Discharge%20Management
%20Plans/D-3%20PDMP%20Complete.pdf
Each contractor engaged in pesticide activities in the pest management area that could impact waters of the United States must be identified and sign the following certification statement.
I certify under penalty of law that I have read and understand the terms and conditions of the
PDMP for the above designated project.
This certification is hereby signed in reference to the above named contract.
Company: _____________________________________________
Address: _____________________________________________
City/State/Zip:_____________________________________________
Telephone Number: ________________________________________
Type of pesticide application service to be provided:
Herbicide, insecticide, and fertilizer applications
Signature: _____________________________________________
Title: _____________________________________________
Date: _____________________________________________
File details come from the government source that posted it. Updated .