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TRENCH SAFETY ACT COMPLIANCE STATEMENT <br />�1 Project Indian River County North WTP Raw Water Transmission S stem <br />J Bid Number # 2010024 <br />Instructions <br />Florida StatutesSections 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 <br />Health Administration's excavation safety standard, found in 29 C.F.R. s. 1926.650 Subpart.P. <br />All prospective contractors are required to sign this Trench Safety Act Compliance Statement <br />and provide compliance cost information where indicated below. The costs for complying with <br />the Trench Safety. Act must be incorporated into this Project's base Bid. Certify this Statement in <br />the presence of a notary public. <br />Certification <br />1. I 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. 1 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 th is Project. <br />2. The stimated. cost imposed by compliance with The Trench Safety Act wilt be: <br />Hca Dollars 'a" per linear foot of trench to be excavated. <br />3. The esti rh.ated'cost imposed by compliance with the Trench Safety Act will be: <br />foo 'tw Dollars $ per square foot of special shoring used. <br />4. The amount listed above has been included within the Base Bid, <br />Certified: VV-LQ� _yam <br />(Contractor) <br />By: <br />(Signature) <br />ri Y%A se s <br />(Typed or Printed Name) <br />STATE OF. L) VZ_Lcko� <br />COONTY <br />_ 2 00>10 <br />The foregoing instrument was acknowledged beforome�this o2�3 day of �Jy <br />by 'D. � '(�-> 0 S <br />who is personally known to m or has produced <br />as entification and who did (did not) take an oath. <br />Nota Public Yo1�* *`tr vtcbet.UMIGh7 <br />rY 3 * *N N&W Public Stets Of F ON& j <br />My Gbenmleslon CudMarch 11; 2012 <br />My Commission Expires: Off- 11— t�1 >� �� Ganun►sel�n#oD?W'm <br />00300-5 <br />t <br />