Pesticide Certification.pdf
PDF 4 KB Posted
- Attached to
- Landscape Maintenance Boone Co I-75 Rest Area
- Solicitation number
- RFB 605 2400000462 3
- Issued by
- Boone County, Kentucky
About this file
This is a Pesticide Certification form required by the Kentucky Department of Transportation for contractors performing pesticide-related work under state contracts. The certification document mandates that any contractor engaged in pesticide activities, including herbicide, insecticide, and fertilizer applications, must comply with the KPDES Pesticide General Permit (KYG99) and the Pesticide Discharge Management Plan (PDMP). Contractors are required to read, understand, and acknowledge the terms and conditions of the PDMP, which is available for review at the specified Kentucky Transportation link. The form requires contractors to provide their company information, address, contact details, and specify the type of pesticide application services to be provided, followed by an authorized representative's signature, title, and certification date.
Contractors who fail to comply with any condition of the PDMP may be subject to substantial penalties or loss of contract. The certification serves as formal acknowledgment that the contractor has reviewed the PDMP requirements and understands the obligations to manage pesticide discharge in a manner that protects waters of the United States. This certification requirement applies to all contractors and subcontractors involved in pest management activities within designated areas, and contractors are encouraged to communicate these requirements to all employees working on the contract.
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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 .