Construction




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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

650-040-05

CONSTRUCTION

05/11





CONTRACTOR CERTIFICATION PREPARATION OF THE STORMWATER POLLUTION PREVENTION PLAN AND DOCUMENTS ASSOCIATED WITH THE NPDES GENERIC PERMIT FOR STORMWATER DISCHARGES FROM LARGE AND SMALL CONSTRUCTION ACTIVITIES








Financial Project #

     


“I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.”

     


Signature Date

           

Name (Contractor) Title

     

Name of Contracting Firm

     


Address or P.O. Box (Contracting Firm)

                 

City State Zip Code

           

Telephone: (Contracting Firm) Area Code Number

     


Email Address of Contracting Firm


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