Pesticide Certification.pdf
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- Solicitation number
- RFB-605-2500000623-1
- Issued by
- Calloway County, Kentucky
About this file
This document is a Contractor Certification form from the Kentucky Transportation Cabinet pertaining to compliance with the KPDES Pesticide General Permit (KYG99) and the Pesticide Discharge Management Plan (PDMP). The certification requires contractors engaged in pesticide activities that could impact waters of the United States to review and sign a document acknowledging their understanding of environmental management requirements. The form is specifically for contractors performing herbicide, insecticide, and fertilizer applications, with a mandatory review of the detailed PDMP available through a provided web link.
The certification includes provisions for potential substantial penalties or contract loss for non-compliance, and requires contractors to advise their employees about PDMP requirements. The form is designed to be completed with company details including name, address, contact information, and a signature from an authorized representative, which serves as a legal certification of understanding the project's environmental management protocols. The document serves as a critical compliance mechanism to ensure environmental protection during pesticide-related contract work, with a focus on preventing potential water contamination and maintaining proper pest management practices.
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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 .