HomeMy Public PortalAboutr 23-040'eza ufton of the �Roxnugh of (fart xet, � J�
#23-40
Date of
AUTHORIZING AN AGREEMENT FOR CERTAIN ANIMAL
AND PLANT HEALTH INSPECTION SERVICES (APHIS)
WITH THE US DEPARTMENT OF AGRICULTURE
WHEREAS, the Borough of Carteret is desirous of entering into a cooperative
agreement with the US Department of Agriculture for certain Animal and Plant Health
Inspection Services (APHIS)/Wildlife Service (WS); and
WHEREAS, the USDA is willing to enter into such an agreement to provide said
specialized services; and
WHEREAS, the Mayor and Borough Council have reviewed said proposal; and
WHEREAS, the Chief Financial Officer has certified that the funds are or will be
available for said purposes; Account #:
NOW, THEREFORE, BE IT RESOLVED by the Mayor and Council of the Borough
of Carteret, County of Middlesex, State of New Jersey, as follows:
1. The appropriate Borough Officials are hereby authorized and
directed to enter into an APHIS/WS with the US Department of
Agriculture for 2023 at a total cost not to exceed $7,825.00.
2. A copy of this Resolution be forwarded to the Director of
Engineering and the Borough's Purchasing Department.
Adopted this 2" day of February, 2023
and certified as a true copy of the
original on February 3, 2023.
CARMELA POGORZELSKI, RMC
Municipal Clerk
RECORD OF COUNCIL VOTE
COUNCILMAN
YES
NO
NV
A.B.
COUNCILMAN
YES
NO
NV
A.B.
BELLINO
X
JOUAL
DIAZ
X
KRUM.
X
DIMASCIO
X
NAPLES
X
X-Indicate Vole AB -Absent NV -Nat Vodng XOR- Indicates Vote to Overrule Veto
Adopted at a meeting of the
Municipal Council
' February 2, 2023
*BOROUGH Or, CARTERET Demia9LReiman, Mayor
MUNICIPAL CLERIC
Date: January 3l 2023
To: Pau'iokDeBlaslo
Treasurer
Borough of Carteret
REQUEST FOR CERTIFICATION OF AVAILABLE FUNDS
For: AUTHORIZING AN AGREEMENT FOR CERTAIN ANIMAL AND V NT HBALTH
Resolution M _ N23-40
Nome of Account; US DEPARTMENT OF AORICULTURB
AMOUNT TO BE ENCUMBERED; Amount not to exceed $7.825, 0/\' /1
I A I rod W)e I JVLt
Municipal Clerk
CERTIFICATION OF AVAILABILITY OF FUNDS
1, Treasurer of tho Borough of Carteret, do hereby certify that there are sofficlent fluids available in the current
budget to enable the Municipal Council to authorlu: the entering into a Contract botween the Borough of Carteret
and;
4111 S
The funds available for this eonnact are in the Budget, in the account of:
-7�0t 79 6 2��(
In the amount of -W 1-"5;
By this certification, I have hereby encumbered the above named account for the amount of the contraot pending
Connell actlon.
Patrick DoBlssio
Treasurer
Date;
Meinot'ltdMunicikallanding ® 61Cookc.A'vertue ® Cat'terat,New fersey07008
7'el: 732-541-3800 ® 11= 732-541-8925 0 c gyTcoflice[�corteret•net
S'rBNSS'S;El:tt:l=�t.net
(7/2019 version)
WS Agreement No: 23 7234 8050 RA
WBS Element: AP.RA.RX34.72.0092
COOPERATIVE SERVICE AGREEMENT
between
BOROUGH OF CARTERET (COOPERATOR)
and
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE (APHIS)
WILDLIFE SERVICES (WS)
ARTICLE 1— PURPOSE
The purpose of this Cooperative Service Agreement is to assist in a Canada goose (Branta
canadensis) damage management project as described in the attached Work Plan.
ARTICLE 2 — AUTHORITY
APHIS-WS has statutory authority under the Acts of March 2, 1931, 46 Stat. 1468-69, 7 U.S.C.
§§ 8351-8352, as amended, and December 22, 1987, Public Law No. 100-202, § 101(k), 101 Stat.
1329-331, 7 U.S.C. § 8353, to cooperate with States, local jurisdictions, individuals, public and
private agencies, organizations, and institutions while conducting a program of wildlife services
involving mammal and bird species that are reservoirs for zoonotic diseases, or animal species
that are injurious and/or a nuisance to, among other things, agriculture, horticulture, forestry,
animal husbandry, wildlife, and human health and safety.
ARTICLE 3 - MUTUAL RESPONSIBILITIES
The cooperating parties mutually understand and agree to/that:
1. APHIS-WS shall perform services set forth in the Work Plan, which is attached hereto and
made a part hereof. The parties may mutually agree in writing, at any time during the
term of this agreement, to amend, modify, add or delete services from the Work Plan,
2. The Cooperator certifies that APHIS-WS has advised the Cooperator there may be private
sector service providers available to provide wildlife damage management (WDM)
services that the Cooperator is seeking from APHIS-WS.
3. There will be no equipment with a procurement price of $5,000 or more per unit purchased
directly with funds from the cooperator for use on this project. All other equipment
purchased for the program is and will remain the property of APHIS-WS.
4. The cooperating parties agree to coordinate with each other before responding to media
requests on work associated with this project.
ARTICLE 4 - COOPERATOR RESPONSIBILITIES
Cooperator agrees:
1. To designate the following, John DuPont, as the authorized representative who shall be
responsible for collaboratively administering the activities conducted in this agreement.
John DuPont, Director of Municipal Engineering
61 Cooke Avenue, Carteret, NJ 07008
732-541-3847
dupontj@earteret.net
2. To authorize APHIS-WS to conduct direct control activities as defined in the Work Plan.
APHIS-WS will be considered an invitee on the lands controlled by the Cooperator.
Cooperator will be required to exercise reasonable care to warn APHIS-WS as to
dangerous conditions or activities in the project areas.
3. To reimburse APHIS-WS for costs, not to exceed the amorally approved amount specified
in the Financial Plan. If costs are projected to exceed the amount reflected in the Financial
Plan, the agreement with amended Work Plan and Financial Plan shall be formally revised
and signed by both parties before services resulting in additional costs are performed. The
Cooperator agrees to pay all costs of services submitted via an invoice from APHIS-WS
within 30 days of the date of the submitted invoice(s). Late payments are subject to
interest, penalties, and administrative charges and costs as set forth under the Debt
Collection Improvement Act of 1996.
4. To provide a Tax Identification Number or Social Security Number in compliance with
the Debt Collection Improvement Act of 1996.
5. As a condition of this agreement, the Cooperator ensures and certifies that it is not
currently debarred or suspended and is free of delinquent Federal debt.
6. To notify APHIS-WS verbally or in writing as far in advance as practical of the date and
time of any proposed meeting related to the program.
7. The Cooperator acknowledges that APHIS-WS shall be responsible for administration of
APHIS-WS activities and supervision of APHIS-WS personnel.
ARTICLE 5 — APHIS-WS RESPONSIBILITIES
APHIS-WS Agrees:
1. To designate the following as the APIIIS-WS authorized representative who shall be
responsible for collaboratively administering the activities conducted in this agreement.
Aaron Guikema, State Director
USDA APHIS WS Program in New Jersey
140 C Locust Grove Road, Pittstown, NJ 08867
908-735-5654
Aaron.T.Guikema@usda.gov
2. To conduct activities at sites designated by Cooperator as described in the Work and
Financial Plans. APHIS-WS will provide qualified personnel and other resources
necessary to implement the approved WDM activities delineated in the Work Plan and
Financial Plan of this agreement.
3. That the performance of wildlife damage management actions by APHIS-WS under this
agreement is contingent upon a determination by APHIS-WS that such actions are in
compliance with the National Environmental Policy Act, Endangered Species Act, and
any other applicable federal statutes. APHIS-WS will not make a final decision to
conduct requested wildlife damage management actions until it has made the
determination of such compliance.
4. To invoice Cooperator quarterly for actual costs incurred by APHIS-WS during the
performance of services agreed upon and specified in the Work Plan. Authorized auditing
representatives of the Cooperator shall be accorded reasonable opportunity to inspect the
accounts and records of APHIS-WS pertaining to such claims for reimbursement to the
extent permitted by Federal law and regulations.
ARTICLE 6 — CONTINGENCY STATEMENT
This agreement is contingent upon the passage by Congress of an appropriation from which
expenditures may be legally met and shall not obligate APHIS-WS upon failure of Congress to so
appropriate. This agreement may also be reduced or terminated if Congress only provides
APHIS-WS funds for a finite period under a Continuing Resolution.
ARTICLE 7 — NON-EXCLUSIVE SERVICE CLAUSE
Nothing in this agreement shall prevent APHIS-WS from entering into separate agreements with
any other organization or individual for the purpose of providing wildlife damage management
services exclusive of those provided for under this agreement.
ARTICLE 8 — CONGRESSIONAL RESTRICTIONS
Pursuant to Section 22, Title 41, United States Code, no member of or delegate to Congress shall
be admitted to any share or part of this agreement or to any benefit to arise therefrom.
ARTICLE 9 — LAWS AND REGULATIONS
This agreement is not a procurement contract (31 U.S.C. 6303), nor is it considered a grant (31
U.S.C. 6304). hi this agreement, APHIS-WS provides goods or services on a cost recovery basis
to nonfederal recipients, in accordance with all applicable laws, regulations and policies.
ARTICLE 10 — LIABILITY
APHIS-WS assumes no liability for any actions or activities conducted under this agreement
except to the extent that recourse or remedies are provided by Congress under the Federal Tort
Claims Act (28 U.S.C. 1346(b), 2401(b), and 2671-2680).
ARTICLE 11— NON-DISCRIMINATION CLAUSE
The United States Department of Agriculture prohibits discrimination in all its programs and
activities on the basis of race, color, national origin, age, disability, and where applicable, sex,
marital status, familial status, parental status, religion, sexual orientation, genetic information,
political beliefs, reprisal, or because all or part of an individual's income is derived from any
public assistance program. Not all prohibited bases apply to all programs.
ARTICLE 12 - DURATION, REVISIONS, EXTENSIONS, AND TERMINATIONS
This agreement shall become effective on February 1, 2023 and shall continue through September
30, 2023, not to exceed five years. This Cooperative Service Agreement may be amended by
mutual agreement of the parties in writing. The Cooperator must submit a written request to
extend the end date at least 10 days prior to expiration of the agreement. Also, this agreement may
be terminated at any time by mutual agreement of the parties in writing, or by one party provided
that party notifies the other in writing at least 60 days prior to effecting such action. Further, in
the event the Cooperator does not provide necessary funds, APHIS-WS is relieved of the
obligation to provide services under this agreement.
4
In accordance with the Debt Collection Improvement Act of 1996, the Department of Treasury
requires a Taxpayer Identification Number for individuals or businesses conducting business with
the agency.
Cooperator's Tax ID No.: 22-6001707
APHIS-WS's Tax ID: 41-0696271
COOPERATOR
Jo DuPont, Director of Mu cipal Engineering �® Date
Borough of Carteret
61 Cooke Avenue, Carteret, NJ 07008
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
WILDLIFE SERVICES
Aaron Guikema, State Director Date
USDA, APHIS, WS
140C Locust Grove Road, Pittstown, NJ 08867
WORK PLAN
In accordance with the Cooperative Service Agreement between BOROUGH OF CARTERET
and the United States Department of Agriculture (USDA), Animal and Plant Health Inspection
Service (APHIS), Wildlife Services (WS), this Work Plan sets forth the objectives, activities and
budget of this project during the period of this agreement.
The USDA is authorized to protect American agriculture and other resources from damage
associated with wildlife. The primary authorities for APHIS-WS are the Act of March 2, 1931
(46 Stat. 1468; 7 USCA 8351-7 USCA 8352) as amended, and the Act of December 22, 1987
(10IStat. 1329-331, 7 USCA 8353). APHIS-WS activities are conducted in cooperation with
other Federal, State and Local agencies; private organizations; and individuals.
The APHIS-WS program uses an integrated wildlife damage management approach in which a
series of methods may be used or recommended to reduce wildlife damage. These methods
include the alteration of cultural practices as well as habitat and behavioral modification to
prevent damage. However, managing wildlife damage may require that the offending animal(s)
be removed or that the local populations of the offending species be reduced.
Proeram Objective
The wildlife damage management program at BOROUGH OF CARTERET will be directed
primarily at reducing human health and safety risks and property damage associated with Canada
geese (Branta canadensis).
Plan of Action
Canada goose presence on BOROUGH OF CARTERET property(s) can negatively impact the
quality of life for residents, patrons and/or employees. Geese can affect human health and safety
through disease concerns associated with feces, aggressive behavior when defending nests or
young, and hazards when on roadways or near airports. Additionally, geese can cause damage to
property and natural resources through overgrazing of vegetation and accumulation of feces in
bodies of water.
APHIS-WS wildlife biologists and specialists, who have been trained in wildlife damage
management, will conduct nest and egg management (egg addling), population monitoring, and
capture and euthanasia of resident Canada geese.
Egg addling inhibits reproduction to prevent local population growth and reduce problems with
localized overpopulation. APHIS-WS will conduct treatment and/or removal of Canada goose
nests and eggs throughout the nesting season, typically March through May.
Population monitoring may occur throughout the length of the agreement. Population monitoring
can include post -nesting and pre -capture surveys, migratory goose population surveys, and/or
surveys of mute swans, feral geese, and feral ducks.
Capture and euthanasia of resident Canada geese will occur one day during the molt period it)
June or July. APHIS-WS and BOROUGH OF CARTERET will determine if other capture
methods are appropriate outside of the molt period, such as carrion nets, bow nets, or other
proposed methods. Birds are euthanized in accordance with recommendations by the American
Veterinary Medical Association and APHIS-WS policy. When applicable, APHIS-WS will
sample and test euthanized birds for research purposes. APHIS-WS will dispose of birds as
permitted by the U.S. Fish and Wildlife Service (USFWS) by burial, incineration or donation for
non-lmman consumption.
APHIS-WS will conduct activities and record take under a USFWS Migratory Bird
Depredation Permit issued to the APHIS-WS program. APHIS-WS will provide a final report
to BOROUGH OF CARTERET summarizing Canada goose management pursuant to this
agreement no later than September 30, 2023.
APHIS-WS and BOROUGH OF CARTERET Agree
1. BOROUGH OF CARTERET will coordinate with APHIS-WS before responding to
media, public requests, or posting information to social media pertaining to wildlife
damage management activities. BOROUGH OF CARTERET will provide a
spokesperson to respond to information requests concerning such activities.
2. APHIS-WS will conduct activities designated in the Work Plan only on the property(s) of
BOROUGH OF CARTERET, unless written permission has been obtained through a
Work Initiation Document for Wildlife Damage Management (WS Form 12A) to conduct
similar activities on neighboring properties.
3. BOROUGH OF CARTERET certifies non -lethal Canada goose management techniques
have been utilized on their property(s) prior to this agreement and will continue non -lethal
techniques. Non -lethal techniques include, but are not limited to, harassment, exclusion,
habitat modification, visual deterrents and/or egg addling.
4. BOROUGH OF CARTERET has implemented a no feeding policy on their property(s).
FINANCIAL. PLAN
Cost Element
Full Cost
Personnel Com ensation
$ 3,993.00
Travel
$ 1,495.00
Vehicles
$ 446.00
Other Set -vices
$ -
Supi2lies and Materials
$ 220.00
Equipment
$ -
Subtotal Direct Charges)
$ 6,154.00
Pooled Job Costs [for non -Over -the Counter
projects]
11.00%
$ 677.00
Indirect Costs
16.15%
$ 994.00
Aviation Flat Rate Collection
$ -
Agreement Total
$ 7,825.00
The distribution of the budget from this Financial Plan may vary as necessary to
accomplish the purpose of this agreement but may not exceed $7,825.
APHIS-WS costs are not based on number of nests found or birds captured but are
instead based on the above line items. Minimal costs will be charged for supplies
purchased and personnel time already expended should activities be deemed unnecessary.
Financial Point of Contact/Billing Address:
BOROUGH OF CARTERET
Name: John P.
Address: 61 Cooke Avenue
Carteret, NJ 07008
Phone Number: 732-2 59-5246,
Email: dupontj@carteret.net
APHIS-WS New Jersey State Office
Lisa Spinelli, Budget Analyst
140 C Locust Grove Road
Pittstown, NJ 08867
lisa.l.spinelli ,usda.gov
909-735-5654
Purchase orders, if applicable, should be submitted to APHIS-WS contact above.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this informaion collection is 05790335. Thetimerequired to complete this infommtioncollection is estimated to average .059
GAT Approved
hours per response, includingthetimo for reviewing instnrations,searchingexis(ing data sources, gathering and mainlainingthedala needed, and completing and mviowingthecollection
0579-0335
ofinfonnation.
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT ❑GALTH INSPECTION SERVICE
WORK INITIATION UOCUATENT FOR
WILDLIFE SERVICES
WILDLIFE DAMAGE MANAGEMENT
WORK INITIATION DOCUMENT NUMBER 2. 5'1'ATUS
S
j1.
1_ O NEW O RENEWAL
E
C
3. TYPE OF WORK INITIATION DOCUldi kill teat apply) Assi n to'fhese S moist Grou s
T
(1) CARTERET,BOROUGHOF&ADJACM V
O PRIVATE PROPERTY NON -PRIVATE PROPERTY 0 TEMPORARY/CIVIL (2) -- V
t � (3) _ V
u ADJACENT LANDOWNER ❑ AMENDMENT TO AN EXISTING WORK INITIATION DOCUMENT (4)
4.Coopemto'steanre DUPONT ----] [JOM
S
First Middle
S. Cooperators Mailing Address rl COORB AVENUE _,_, CARTFRET —� N7 07008
E
C
T
I
Address __ City _ State Zip Code
6. Common Nmnc CARTERET, BOROUGH OF _ 7, 732-541-3847
0
N
Cooperator Phone Number
8.0wnet'sor Representative's Name
- -
(tfdi wentfieenCoe, erator's) �� 19.
2
Last First Owner/Rep. Phone Number
10. Owner's or Representative's Address
(if differentfia.. Cooperator's)_-
__...
Address City State Zip Code
II.PROPERTY/ LAND CLASS INFORMATION
COUNTY PROPERTY LAND CLASS ACRES
12. ADJOINING
PROPERTY WIT) NOS
11TARGETEO SPECIES
EA.
MIDDLCSBX V BOROUGH ( --NT'Y V 100
A, �_
A, DUCKS, FERAL � g L
D.rMIDDLESHX V] CARTERET COUNTY V 18
B. G.= l
T
IL
I
C,
C, GEESE, FERAL__ y,
C. MNDLESEX V RET'ENTIOb, COUNTY V �]
OD.
D.0
MIDDLESEX V'VETERAN'S COUNTY V 20
D. SWANS, MUTE 1.
J.
Lj
STATE: NJ TOTAL ACRES 143
❑ 14. There are additional target species(Complete nndau,,h FSFomr 12 Addendum)
S
I5. to wnsidention ofthe benefits to be derived from the proper management ofdamage caused by @ose species listed in Section 3Item 14, (and Item 15. if applicable), I the undersigned mopemmr er Coope'amea tomenomodw, do
hereby,ive m,O.mort and Comemrence to the Animal and Plant health Inspection Servitt(APHIS)R. includes itsomcials, employees, and agents) tousc, upon lands owned, lezed,mwn,nvise controlled by me, and identified by
E
this Work lonflation Document, the folloodog methods and devices:
CAR/TRUCK C. HAND Tool'sC A. [BO=AT B.
—
T
D. HANDCAUCHT/GATHERED E. TRAP$, DRIVE —�E�_—
16. ❑ There are additirum,omponenls (complete ond,furcb IYSFam 12Addendmn)
$
g
C
.h
17.1, the cooperator or cooperators representative have been fifomredofthenmthods and the manse' in which the Control materials coma devices listed in Section 4 will beused, and oflhe passible hazards associated wild their use.I
understand that AHES,(10 include ilsoficere, employees endegents)will: exercis mwenablepreerdwas maafeguard all persons toprevent injury toanimal fifeo@er than those listed in Section 3, Rem 14. (and llem D., if
applicable); guard against themiehandlin,ofcontrol desk,snndmatedds; and exercise due caution and properjudgment in all wildlife damage management operations. l understand that APHIS, WS, will maintain reslticted use
pesticide application records on applications made under the Work Initiation Document, and that APHIS, WS willismeide copies Colic recordsorremrd informatier,marptly upon the property owners or coopembres request.[
understand that APHIS may collect Global Positioning System (]PS) Coordinates at project site as part ofcompoment or activity tracking or as wildlife disease monitoring ormseerch data. As a Lessee, the Cooperator agrees that
the lease k omen and wil I remain,.,Lilo APHIS WS conducts mpemtionnl activities muse property and will notify WS if the lease expires or is Canceled. The Lessee agrees to notify the lando,ner about any methods or devices
5
(components) in use by APHIS WS on the property.
E18.
C
T
in Consideration ofthese understandings and ofthe benefts 1. be derived,I,thecoopemtor or cooperators representaive,agree Im mice reasonable precautions to prevent injury to livestock and other domestic animals;assume
respousibility for injury to my property under my control, when said injury is not the result ofnegligence on me part of APHIS; assist in maintaining such roaming signs as APHIS may place for the purpose ofeotifyin, persons entering
onto such lands ofthe possible hazards azsocieted wimeildlife dams,¢ management measures in use maroon; and to give ade,natewamin, of these possible bamrds to persons l amhorize to enter onto such lands. Father, in
recognition ofthe benefits le be derived room me me ofspecifed methods and devices authorized by this Work Initiation Document, 1, me cooperator or Cooperators representative, agree notas
nc n couemnly me or allow to be used upon
6
land s covered by this Work Initiation Document, any toxic material that might reasonably be expected 1. take a species listed above in Section 3, Item 14. (and llem IS., iin,beeble) unless use Cloud toxicant is agreed 1. by
APHIS in writing.
Mute svaass and fern) ducks/geese will only be surveyed. ,
19. SPECIAL CONSIDERATIONS:
20A. LANDOWNER, LESSER, OR ADMINISTRATOR NAME AND TITLE
ATUREANDTITI s
20C. DATE
Jo n P. DuPont Director
21A, APHIS REPRESENTATIVE NAME
2113. St 'NATURE
NICOLE REIN, Dae:202z9;2;
1
��'7e5-05 0'
NICOLe E REIN
21D.APHIS REPRESENTATIVE TELEPHONE NUMBER
908-735-5654 X9
21 G. STATE OFFICE ADDRESS
140-C Locust Grove Rd, Pittstown, NJ 08867
1VS FORM 19A - c —1—ir. vn.dnn
Instructions for Completing WS Form 12A,
Work Initiation Document For Wildlife Damage Management
NOTE: A WS Form 12A Work Initiation Docanrent (\YID) is required to be signer) by a Cooperator for all properties worked by Wildlife Services (WS).
The WID and the WID agreement in WS Management Information System (Ails) expire 5 years offer the Cooperator sigsmture date, To renew a Will
agreement far another 5 years, a nor WS Form 12A is required to be signed by the Cooperator, and everndhinn on the WIDagreement in HIS nost mamlm
the corresponding items on the WS Form 12A.
NOTE; An expanded and detailed set of instructions for the WID is available in MIS. Employees should study the detailed version until familiar with
completing the WILL
SECTION 1 . Basic WID Identification and Type
1. Entering the WID document number is optional, Contact your MIS Data Technician to obtain this number if one is needed.
2. Mark only one box, selecting Now (agreement) or Renewal (ofexisting agreement).
3. A WID may have more than one type ofwork characteristic. Mark all applicable boxes indicating this W rDs type ofwork.
SECTION 2. Cooperator Information
4. Enter the alone of the Cooperator as it appears on the Cooperative Service Agreement, Cooperative Service Field Agreemon,Memorondu n ofAgreenwat or Understanding, or as it
appears in the Ceoperaloms business references,
5. prior the Cooperators mailing address with street or P.O. box, city, state, and ZIP code. This may be the permanent address, mailinglak ress, home address, or business/office address.
6. Enter the common name of the Coopemons business, farm, or ranch, if applicable.
7. Enter the Cooperators telephone number including the area code. It may be a ]earth= or mobile telephone number.
8. Enter the name of the owner or Cooperand.s representative if it is different from the Cooperators name.
9.Enter the property creams or property owner representatives telephone number including area code.
10. Enter the property owners address (or property owner representatives work address ifthls is a business or a non -private agrecnent),including the ZIP code, If the Cooperators address
in Item 5 is also the owners address, skip this step,
SECTION 3 . Property lateral ation, Location of Work, and Species Being Addressed
11. In this subsection, record the state and counties for the shots) where the work is being performed for the cooperator. Include for eachproperty the land class being worked on and the
number of acres for the land class. Usually, only one land class can be recorded per property, Iflhere is more than one land class on a property, identify each of them separately (e.g.
Property: Smith 61, Land Class Private; Smith N2, Land Class County/City). Record the total acres by summing all entries in tlrc.Acres. column.
12, If the WID allows work on an adjoining properly as part of the project, additional Wills signed by the adjoining landowners/ managers mustbe obtained. The WID document numbers
for the adjoining properties go in this subsection. If WID numbers are not assigned, list the name of the other land owners/managers instead of numbers.
13, List the full common names of the targeted species as found in MIS. Review MIS Reference Files for accuracy.
14. If more than 10 species are targeted, mark this box and list the additional species on WS Form 12 Addendum. The WE Food 12A alsorequiresan original signature. Ensure the WS
Foram 12 Addendum is attached to this WS Foram 12A.
SECTION 4 . Component Use Information
15. List the components that will be used ill the project. They must be annotated exactly as they appear in the MIS component list. Do not list any activities (e.g., shooting, trapping, etc.).
16. If ... ore than six components are entered, mark this box and list the additional components on WS Foram 12 Addendum The WS Tom 12Addendum also requires an original signature.
Ensure the addendum is attached to this WS Form 12A.
Section 5. Work Initiation Considerations, WS Responsibilities
17. The Cooperator is required to read this section, or alternatively have it read to lonelier, before signatures are affixed to the WID.
Section 6 . Work Liddell oil Considerations, Cooperator Responsibilities
18. The Cooperator is required to read this section, or alternatively have it read to himadr, before signatures arc affixed to the WID.
19. Special Considerations - If any special considerations arc agreed to for this project, enter them in Item 19. They may also be entered Indic MIS in the Agreement Remarks or the
Property Comments fields.
20, 2 L Signatures/Dates - To complete the form, both the Cooperators authorized signer and the APHIS Representravo (WS employee) print their names, sign in ink, and date the WS
Foram 12A. The WS employee also enters a contact telephone number mid the State Offico.s address.
Tie WE employee is responsible for ensuring the Cooperator or authorized representative receives a copy offer WS Privacy Act Notice.
PRIVACY ACT NOTICE
Title 5 United States Code, Section 552a(e)(3) requires that each agency that maintains a system of records provide each individual from whom the agency solicits
information with the following infomation.
AUTHORITY FOR REOUESTING INFORMATION
Title 7, United States Code, Section 8351 to 8353, and Title 16 United States Code, Section 667, authorizes officers, agents, and employees of the United States Department
of Agriculture (USDA), Animal and Plant Health Inspection Service (APHIS), Wildlife Services (WS) to conduct a program of wildlife services and to enter into agreements
with States, local jurisdictions, individuals, and public and private agencies, organizations, and institutions for the purpose of conducting such services.
NATURE OF YOUR DISCLOSURE OF INFORMATION
Disclosure of information solicited by USDA, APHIS, Wildlife Services is voluntary.
PRINCIPLE PURPOSE FOR WHICH THE INFORMATION IS SOLICITED
Information is solicited from you for the purpose of executing and implementing agreements for control of wildlife damage.
ROUTINE USES WHICH MAY BE MADE OF THE INFORMATION
(1) To cooperative Federal, State, Tribal, and local government officials, employees, ore ontractors and other parties as necessary to carry out the program; and other parties
engaged to assist in administering the program. Such contractors and other parties will be bound by the nondisclosure provisions of the Privacy Act. This tontine use assists
the agency in carrying out the program, and thus is compatible with the purpose for which the records are created and maintained;
(2) To the appropriate agency, whether Federal, State, local, Tribal, or foreign, charged with responsibility of investigating or prosecuting a violation of law or of enforcing,
implementing, or complying with a statute, rude, regulation, or order issued pursuant thereto, of any record within this system when information available indicates a
violation or potential violation of law, whether civil, criminal, or regulatory in native, and either arising by general statute or particular program statute, or by title,
regulation, or court order issued pursuant thereto;
(3) To the Department of Justice when the agency, or any component thereof, or any employee of the agency in his or her official capacity, or any employee of the agency in
his or her individual capacity where the Department of Justice has agreed to represent the employee, or the United States, in litigation, where (he agency determines that
litigation is likely to affect the agency or any of its components, is a party to litigation or has air interest in such litigation, and the use of such records by the Department of
Justice is deemed by (lie agency to be relevant and necessary to the litigation; provided, however, that in each case, the agency determines that disclosure of the records to
the Department of Justice is a use of the information contained in the records that is compatible with the purpose for which the records were collected;
(4) For use in a proceeding before a court or adjudicative body before which the agency is authorized to appear, when the agency, or any component thereof, or any
employee of the agency in his or her official capacity, or any employee of the agency in his or her individual capacity where Clio agency has agreed to represent the
employee, or the United States, where the agency determines that litigation is likely to affect the agency or any of its components, is a party to litigation or has an interest in
such litigation, and the agency determines that use of such records is relevant and necessary to the litigation; provided, however, that in each case, the agency determines that
disclosure of the records to the court is a use of the information contained in the records that is compatible with the purpose for which the records were collected;
(5) To appropriate agencies, entities, and persons when the agency suspects or has confirmed that the security or confidentiality of information in (lie system ofrecords has
been compromised; Clio agency has debandried that as a result of the suspected or confirmed compromise, there is a risk of ]term to economic or property interests, a risk of
identity theft or fraud, or a risk of harm to the security of integrity of this system or other systems or programs (whether maintained by the agency or another agency or
entity) that rely upon the compromised information; and the disclosure made to such agencies, entities, and persons is reasonably necessary to assist in connection with 11te
agency.s efforts to respond to the suspected or confined comproruise and prevent, minimize, or remedy such halm;
(6) To USDA contractors, partner agency employee or contractors, or private industry employed to identify patterns, trends, or anomalies indicative of fraud, waste, or
abuse;
(7) To land management agencies, such as the Bureau of Land Management and the U.S. Fish and Wildlife Service, relating to wildlife damage on grazing allotments;
(8) To consumer reporting agencies in accordance with 31 U.S.C. 3711(e);
(9) To Federal, State, Tribal, and local regulatory agencies and (heir employees and contractors who collaborate with Wildlife Services in implementation of, or agencies that
regulate, wildlife management projects or programs, or who have an interest in, or regulate, animal or public health, or national security;
(10) To Federal or State Government -level representatives of the U.S. Environmental Protection Agency, in compliance with the Federal insecticide, Fungicide, and
Rodenticide Act (FIFRA) mandate (7 U.S.C. 136), of the location on a cooperators property where certain regulate([ pesticide devices are deployed or regulated pesticides
are applied; and
(11) To the National Archives and Records Administration (NARA) or to the General Services Administration for records management inspections conducted under 44
U.S.C. 2904 and 2906.
EFFECTS OF FAILURE TO FURNISH INFORMATION
Failure to provide the solicited information will not subject you to penalties or adverse consequences.