**STATEMENT OF WORK**

USDA, Natural Resources Conservation Service

Wisconsin

**Pest Management (595)**

**DESIGN (911)**

**Deliverables:**

1\. Design documents that demonstrate criteria in NRCS practice standard
have been met and are compatible with planned and applied practices.
Practice standard criteria-related computations and analyses to develop
plans and specifications including but not limited to:

> a\. Identification of targeted species.
>
> b\. Control methods (e.g. biological, cultural, chemical, mechanical).
>
> c\. Environmental risk assessment of planned control method.
>
> d\. Mitigation techniques, if necessary.

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.
Plans and specifications shall be developed in accordance with the
requirements of conservation practice standard Pest Management (Code
595).

3\. Documentation of needed operation and maintenance.

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

5\. Required documentation of design modifications during practice
installation.

6\. Itemized cost estimate.

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

**Pest Management (595)**

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

**Pest Management (595)**

**INSTALLATION (912)**

**Deliverables**

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

2\. Verification that client has obtained required permits.

3\. Layout and communication of setback requirements for wetlands, water
bodies, streams and other pest control-sensitive areas.

4\. Application 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
installation.

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

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

**Pest Management (595)**

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

**Pest Management (595)**

**CHECKOUT (913)**

**Deliverables**

1\. Records of application to include but not limited to:

> a\. Extent of practice units applied and location identified on a map.
>
> b\. Actual materials/control method/mitigation techniques used.
>
> c\. Application rate, method and timing of pest control activities.
>
> d\. Mitigation practices implemented to address identified
> environmental risks.
>
> e\. Certification that the application meets NRCS standards and
> specifications and is in compliance with permits.

2\. 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

3\. Documentation of exit conference with client.

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

**Pest Management (595)**

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

**Pest Management (595)**

**REFERENCES**

-   WI NRCS Field Office Technical Guide (eFOTG), Section IV,
    Conservation Practice Standard 595, Pest Management

-   NRCS General Manual 190, Part 404

-   NRCS National Agronomy Manual (NAM)

-   NRCS Windows Pesticide Screening Tool (WIN-PST)

-   ARS National Agricultural Pesticide Risk Analysis (NAPRA)

-   NRCS National Environmental Compliance Handbook

-   NRCS Cultural Resources Handbook