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PERMITTEE'S AFFIDAVIT REGARDING POLLUTION <br />This sworn statement is submitted to Indian River County for the following project (list <br />project name and site address): OLD DIXIE HIGHWAY AND HIGHLAND DRIVE <br />INTERSECTION IMPROVEMENTS, VERO BEACH, FLORIDA 32962. <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 />, who upon oath duly <br />whose business address is <br />and (if applicable) its Federal Identification No.(FEIN) is <br />2. My name is and my relationship to the <br />entity named above is <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 <br />conditions of the Stormwater Management System Permit issued by Indian River <br />County, Permittee is responsible for complying with the terms and conditions of the <br />following as applicable to 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. Permittee understands and agrees that "pollution" as defined by Florida Statutes <br />Chapter 403.031(7) includes: "... the presence in the outdoor atmosphere or waters of <br />the state of any substances, contaminants, noise, or manmade or human -induced <br />impairment of air or waters or alteration of the chemical, physical, biological, or <br />radiological integrity of air or water in quantities or at levels which are or may be <br />01025-11 Technical Specifications <br />F:\Public Works\ENGINEERING DIVISION PROJECTS \1362-01d Dixie Hwy_Highland Dr\1-Admin\Bid Documents\Master Contract <br />Documents\Technical Specifications.doc <br />