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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): <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 />who upon oath duly <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. 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 />Last revised: 6/29/2018 I . <br />\public works\engineering division projects\1760 victor hart sr. complex drainage improvements\1-admin\bids\bid documents\irc- <br />1760_40pen_c_20180813.doc <br />