**STATEMENT OF WORK**

USDA, Natural Resources Conservation Service

Wisconsin

**Firebreak (394)**

**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\. Compliance with NRCS national and state utility safety policy (NEM
> part 503-Safety, Section 503.00 through 503.22).
>
> b\. List all required and/or facilitating practices.
>
> c\. Practice standard criteria-related computations and analyses to
> develop plans and specifications including but not limited to:
>
> i\. Firebreak location, width and length.
>
> ii\. Vegetative species selection and estimated quantities needed by
> species.
>
> iii\. Erosion control measures

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}**

**Firebreak (394)**

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

**Firebreak (394)**

**INSTALLATION (912)**

**Deliverables**

1\. Documentation of pre-installation conference with client.

2\. Verification that client has obtained required permits.

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

4\. Installation guidance as needed.

5\. Facilitate, implement and document 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
application.

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

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

**Firebreak (394)**

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

**Firebreak (394)**

**CHECKOUT (913)**

**Deliverables**

1\. Records of installation.

> a\. Extent of practice units applied and location on a map.
>
> b\. Actual materials used.

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

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}**

**Firebreak (394)**

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

**Firebreak (394)**

**REFERENCES**

-   WI NRCS Field Office Technical Guide (eFOTG), Section IV,
    Conservation Practice Standard 394, Firebreak

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-   NRCS National Forestry Manual

-   NRCS National Forestry Handbook

-   NRCS National Engineering Manual

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```
-   NRCS National Environmental Compliance Handbook

-   NRCS Cultural Resources Handbook