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TRENCH SAFETY ACT COMPLIANCE STATEMENT <br />Project 16" Reuse 'Water Main Extension Atone, Lateral G Ca <br />Water Main -- 67 Street to 63rd Street <br />Bid Number 2009046 -- UCP # 2830 <br />Instructions <br />Florida Statutes Sections 563.60 through 553.64, known as the 'Trench Safety Act' requires all <br />contractors engaged by Indian Fiver County, Florida to comply with Occupational Safety and <br />Health Administration's excavation safety standard, found in 29 C.F.R. s. 1926.650 Subpart P. All <br />prospective contractors are required to sign this Trench Safety Act Compliance Statement and <br />provide compliance cost information where indicated below. The casts for complying with the <br />Trench Safety Act must be incorporated into this Projects base Sid. Certify this Statement in the <br />presence of 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 G.F.R. section 1926.650 Subpart P. i will comply with The Trench Safety <br />Act and I will design and provide trench safety systems at all trench excavations in excess of five <br />feet in depth for this Project. <br />2. The estimated cost imposed by corrallintire with The Trench Safety Act will be: <br />-_ Dollars1.00 per linear foot of trench to be excavated. <br />3. The estimated cost imposed by compliance with the Trench Safety Act will be: <br />len _ ollars1_ o. per square foot of special shoring used. <br />4. The amount listed above has been included within the Base Bid. <br />Title: President <br />STATE OF: El ar i da _ <br />COUNTY OF: I'nLk <br />The foregoing instrument was acknowledged before me this 2001day of July . _,2009 <br />by__-- - Jason Chambers <br />wbo is <br />Notary <br />My Commission Expires: <br />(affix seal) <br />it, <br />100 "M <br />or has produced <br />take an oath. <br />�. �kc ', Zi dar l r irr 3C�4rMa�is -G nbi*W (*21 A OTIO ;+ SION CW3W W Foot dac. <br />