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Bid No. 2019016/IRC-1631 <br />PERMITTEE'S AFFIDAVIT REGARDING POLLUTION <br />This sworn statement is submitted to Indian River County for the following project (list project <br />name and site address): <br />STATE OF <br />COUNTY OF <br />Personally before me the undersigned authority, appeared <br />administered, stated as follows: <br />1. This sworn statement is submitted by the PERMITTEE, <br />whose business address is <br />and (if applicable) its Federal Identification No.(FEIN) is <br />2. My name is <br />entity named above is. <br />who upon oath duly <br />and my relationship to the <br />(If signing as Owner's Agent, attach Letter of Authorization to Sign from Owner) <br />3. Permittee understands and agrees that in addition to complying with the terms and conditions <br />of the Stormwater Management System Permit issued by Indian River County, Permittee is <br />responsible for complying with the terms and conditions of the following as applicable to the <br />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 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. Permittee understands and agrees that "pollution" as defined by Florida Statutes Chapter <br />403.031(7) includes: "... the presence in the outdoor atmosphere or waters of the state of any <br />Page 43 of 45 <br />