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Data Flow Systems <br /> (Company Name ) <br /> TRENCH SAFETY ACT COMPLIANCE STATEMENT <br /> Project REUSE DISTRIBUTION AUTOMATION SYSTEM <br /> I <br /> Bid Number 2011032 — UCP #40659 I <br /> Instructions <br /> Florida Statutes Sections 553 . 60 through 553 . 64 , known as the "Trench Safety Act" requires all <br /> contractors engaged by Indian River County, Florida to comply with Occupational Safety and Health <br /> Administration ' s excavation safety standard , found in 29 C . F . R . s . 1926 . 650 Subpart P . Ali <br /> prospective contractors are required to sign this Trench Safety Act Compliance Statement and <br /> provide compliance cost Information where Indicated below . The costs for complying with the Trench <br /> Safety Act must be incorporated into this Project's base Bid , Certify this Statement In the presence of <br /> a notary public . <br /> Certification <br /> 1 . 1 understand that the Trench Safety Act requires me to comply with OSHA excavation safety <br /> standards found In 29 C . F . R . section 1926 . 650 Subpart P . I will comply with The Trench Safety Act <br /> and 1 will design and provide trench safety systems at all trench excavations in excess of five feet in <br /> depth for this Project . <br /> 2 . The eNstimmated cost imposed by compliance with The Trench Safety Act will be : <br /> Dollars__ per linear foot of trench to be excavated . <br /> 3 . The estimated cost imposed by compliance with the Trench Safety Act will be : <br /> N /A <br /> Dollars $ per square foot of special shoring used . <br /> 4 . The amount listed above has been Included within the Base Bid . <br /> Certified ; Data Flow Systems , Inc . <br /> (C r [or) " <br /> By, <br /> ( Signature) <br /> Thomas F . Smaidris <br /> (Typed or Printed Name) <br /> Title : President <br /> i <br /> i <br /> STATE OF : FIorItro,, <br /> COUNTY OF ; lbre %SGz.o <br /> The foregoing instrument was acknowledged before me this r S day of Mlu di , 20 It by <br /> V i S of P 16 to S Swn15T�62C wba-� is <br /> personally known to me or has produced as identification and who did <br /> (did not) take an oa <br /> L <br /> IL <br /> AW A`eNotary Public State of Florida <br /> , Deborah Caskey-WilkinsonNotary Public. .4 affix seal ) F M Commission DD768998y° <br /> Expires 03129l2012 <br /> My Commission Expires : A6urc t� �9 <br /> * *** k *****k ******* ##*** ** * A * * * * ***** * A* **# ******* * ** ** *# ***i * A*A *k* * k* k ** **k * k*# k# A** # k* # ** **#** #** ** * ## *#*k **# * ***** <br /> 00300-7 <br /> FAUlllitlesWTILITY - EMPLOYEE FOLDERSILerry l3rownTront End DocsW0300 Bid Form Reuse aulomation.doc <br />