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CONTRACTOR'S AFFIDAVIT REGARDING POLLUTION <br />This sworn statement is submitted to Indian River County Project No. 1137 for <br />Old Dixie Highway Resurfacing (From the I.R.F.W.C.D. North Relief Canal to 71st <br />Street) <br />STATE OF _ <br />COUNTY OF <br />Personally before me the undersigned authority, appeared <br />who upon oath duly <br />administered, stated as follows: <br />1. This sworn statement is submitted by the CONTRACTOR <br />whose business address is <br />and (if applicable) its Federal Identification No.(FEIN) is <br />2. My name is <br />and my relationship to the <br />entity named above is <br />(If signing as Owners Agent, attach Letter of Authorization to Sign from Owner) <br />3. 1 understand and agrees that in addition to complying with the terms and conditions of the <br />Stormwater Management System Permit issued by Indian River County, Contractor is <br />responsible for complying with the terms and conditions of the following as applicable to <br />the site: <br />(a) State of Florida Generic Permit for Stormwater Discharge From Large and Small <br />Construction Activities (for projects one acre or larger), <br />(b) Stormwater Pollution Prevention Plan (regardless of project size), <br />(c) St. Johns River Water Management District permit(s) (regardless of project size), <br />(d) Florida Department of Environmental Protection permit(s) (regardless of project <br />size), <br />(e) All other permits required for this project not specifically listed herein, and <br />(f) All Codes and Ordinances of Indian River County. <br />4. 1 understand and agrees that "pollution" as defined by Florida Statutes Chapter 403.031(7) <br />includes: ". . . the presence in the outdoor atmosphere or waters of the state of any <br />substances, contaminants, noise, or manmade or human -induced impairment of air or waters <br />or alteration of the chemical, physical, biological, or radiological integrity of air or water in <br />quantities or at levels which are or may be potentially harmful or injurious to human health or <br />01025-20 Technical Specifications <br />FAPublic Works\ENGINEERING DIVISION PROJECTS\1137-Old Dixie Hwy Resurfacing IRF North Relief Canal to 71st St\Admim\bid <br />documents\Contract Documents\Technical Specifications REVISED.doc <br />