**STATEMENT OF WORK**

USDA, Natural Resources Conservation Service

Wisconsin

**Fish Passage** (**396)**

**DESIGN (911)**

**Deliverables:**

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

> a\. Compliance with NRCS national and state utility safety policy (NEM
> Part 503-Safety, Subpart A - Engineering Activities Affecting
> Utilities 503.00 through 503.06).
>
> b\. Practice standard criteria related computations and analyses to
> develop plans and specifications including but not limited to:
>
> i\. Hydrology/hydraulics.
>
> ii\. Structural.
>
> iii\. Environmental Considerations (GM 190 ECS-Part 410.22).

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\. Design Report and Inspection Plan as appropriate (NEM Part 511,
Subpart B Documentation, 511.11 and Part 512, Subpart D Quality
Assurance Activities, 512.30 through 512.32).

4\. Operation and maintenance plan.

5\. Certification that the design meets practice standard criteria and
comply with applicable laws and regulations (NEM Subpart A, 505.03 (a)
(3)).

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

7\. Itemized engineer's cost estimate.

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

**Fish Passage** (**396)**

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

**Fish Passage** (**396)**

**INSTALLATION (912)**

**Deliverables**

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

2\. Verification that client has obtained required permits.

3\. Staking and layout according to plans and specifications including
applicable layout notes.

4\. Installation inspection (according to inspection plan as
appropriate):

> a\. Actual materials used (Part 512, Subchapter D Quality Assurance
> Activities, 512.33).
>
> b\. Inspection records.

5\. Facilitate and implement required design modifications with client,
original designer, 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 installation process and materials meets
design and permit requirements.

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

**Fish Passage** (**396)**

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

**Fish Passage** (**396)**

**CHECKOUT (913)**

**Deliverables**

1\. As-Built documentation.

> a\. Extent of practice units applied and location identified on a map.
>
> b\. Drawings.
>
> c\. Final quantities.

2\. Certification that the installation meets NRCS standards and
specifications and is in compliance with permits (NEM Subpart A, 505.03
(c) (1)).

3\. 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

4\. Documentation of exit conference with client and contractor.

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

**Fish Passage** (**396)**

**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

**Fish Passage** (**396)**

**REFERENCES**

-   WI NRCS Field Office Technical Guide (eFOTG), Section IV,
    Conservation Practice Standard 396, Fish Passage

-   NRCS General Manual (GM)

-   NRCS National Engineering Manual (NEM).

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-   NRCS National Environmental Compliance Handbook

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-   NRCS Cultural Resources Handbook

-   NRCS National Biology Manual

-   NRCS National Biology Handbook