**STATEMENT OF WORK**

USDA, Natural Resources Conservation Service

Wisconsin

**Prescribed Burning (338)**

**DESIGN (911)**

**Deliverables:**

1\. Design documents that demonstrate criteria in NRCS practice standard
have been met and are compatible with planned and applied practices.

> a\. Practice standard criteria-related computations and analyses
> prepared by an individual with required certifications presented in a
> written burn plan including but not limited to:
>
> i\. Description of the burn area including present vegetation cover.
>
> ii\. Objective and timing of burn.
>
> iii\. Acceptable conditions for prescribed burn.
>
> iv\. Preparation of the area for burning including size and location
> of firebreaks.
>
> v\. Safety requirements and notifications.
>
> vi\. Special precaution areas.
>
> vii\. Firing technique.
>
> viii\. Notification of liability.

2\. Written plans and specifications including location map, sketches
and drawings shall be provided to the client that adequately describes
the requirements to install the practice and obtain necessary permits.

3\. Operation and maintenance plan.

4\. Certification that the design meets practice standard criteria and
comply with applicable laws and regulations.

5\. Documentation requirements for design modifications during practice
installation.

6\. Itemized cost estimate.

**[CERTIFICATION OF COMPLETION]{.underline}**

**Prescribed Burning (338)**

Design (911)

**[Program Participant Information]{.underline}**

Name (print):

Contract Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Contract
Item #(s):

**[Technical Service Provider Information]{.underline}**

Name (print):

TSP ID Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Expiration Date:

*I hereby certify that the technical services I provided as a Technical
Service Provider for this component(s) checked above: (1) comply with
all applicable Federal, State, Tribal, and Local laws and requirements,
(2) meet applicable USDA NRCS conservation practice standards,
specifications, and program requirements, (3) are consistent with and
meet the particular conservation program goals and objectives, (4) that
I have provided the above named Program Participant the Deliverables in
this Statement of Work for this component, and (5) comply with all
"Certification Terms" as identified in the Technical Service Provider
Certification Agreement.*

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

***Technical Service Provider Signature Date***

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

***Received By (NRCS staff)** **Date***

**STATEMENT OF WORK**

USDA, Natural Resources Conservation Service

Wisconsin

**Prescribed Burning (338)**

**INSTALLATION (912)**

**Deliverables**

1\. Documentation of pre-application conference with client and
contractor.

2\. Verification that client has obtained required permits.

3\. Staking and layout (e.g., setbacks) according to plans and
specifications including applicable layout notes.

4\. Application oversight as required.

5\. Facilitate, implement and document required design modifications
with client, contractor, permitting and funding agencies.

6\. Advise client/NRCS on compliance issues with all federal, state,
tribal, and local laws, regulations and NRCS policies during
installation.

7\. Certification that the application process and materials meets
design and permit requirements.

**[CERTIFICATION OF COMPLETION]{.underline}**

**Prescribed Burning (338)**

Installation (912)

**[Program Participant Information]{.underline}**

Name (print):

Contract Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Contract
Item #(s):

**[Technical Service Provider Information]{.underline}**

Name (print):

TSP ID Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Expiration Date:

*I hereby certify that the technical services I provided as a Technical
Service Provider for this component(s) checked above: (1) comply with
all applicable Federal, State, Tribal, and Local laws and requirements,
(2) meet applicable USDA NRCS conservation practice standards,
specifications, and program requirements, (3) are consistent with and
meet the particular conservation program goals and objectives, (4) that
I have provided the above named Program Participant the Deliverables in
this Statement of Work for this component, and (5) comply with all
"Certification Terms" as identified in the Technical Service Provider
Certification Agreement.*

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

***Technical Service Provider Signature Date***

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

***Received By (NRCS staff)** **Date***

**STATEMENT OF WORK**

USDA, Natural Resources Conservation Service

Wisconsin

**Prescribed Burning (338)**

**CHECKOUT (913)**

**Deliverables**

1\. Records of application.

> a\. Documentation of weather and moisture conditions during burn.
>
> b\. Complete a post burn evaluation to determine if the objectives of
> the burn were achieved.
>
> c\. Extent of practice units applied and location identified on a map.

2\. Certification that the application meets NRCS standards and
specifications and is in compliance with permits.

3\. Exit conference with client and contractor.

4\. Provide the following information to the NRCS field office servicing
the relevant land unit for entry into the Performance Results System
(PRS):

> a\. Technical Service Provider Name
>
> b\. Customer name
>
> c\. USDA program funding the practice (if known)
>
> d\. Location of work (state, county, conservation district, land tract
> identifier)
>
> e\. Land use of field where the practice was installed (cropland,
> etc.)
>
> f\. NRCS practice name and quantity of practice installed in
> appropriate units

**[CERTIFICATION OF COMPLETION]{.underline}**

**Prescribed Burning (338)**

Checkout (913)

**[Program Participant Information]{.underline}**

Name (print):

Contract Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Contract
Item #(s):

**[Technical Service Provider Information]{.underline}**

Name (print):

TSP ID Number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Expiration Date:

*I hereby certify that the technical services I provided as a Technical
Service Provider for this component(s) checked above: (1) comply with
all applicable Federal, State, Tribal, and Local laws and requirements,
(2) meet applicable USDA NRCS conservation practice standards,
specifications, and program requirements, (3) are consistent with and
meet the particular conservation program goals and objectives, (4) that
I have provided the above named Program Participant the Deliverables in
this Statement of Work for this component, and (5) comply with all
"Certification Terms" as identified in the Technical Service Provider
Certification Agreement.*

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

***Technical Service Provider Signature Date***

*\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

***Received By (NRCS staff)** **Date***

**STATEMENT OF WORK**

USDA, Natural Resources Conservation Service

Wisconsin

**Prescribed Burning (338)**

**REFERENCES**

-   WI NRCS Field Office Technical Guide (eFOTG), Section IV,
    Conservation Practice Standard 338, Prescribed Burning

-   NRCS General Manual

-   NRCS National Environmental Compliance Handbook

-   NRCS Cultural Resources Handbook