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TRENCH SAFETY ACT COMPLIANCE STATEMENT <br /> Project Name : Vero Lake Estates Master Planned 12 " Water Transmission Main <br /> Project Number: <br /> Project Location : Indian River County, FL <br /> Instructions : Florida Statutes Section 553 . 60 through 553 . 64 , known as the "Trench <br /> Safety Act" requires all contractors engaged by Indian River County , Florida to comply <br /> with Occupational Safety and Health Administration 's excavation safety standard , found <br /> in 29 C . F . R . s . 1926 . 650 Subpart P . All prospective contractors are required to sign this <br /> Trench Safety Act Compliance Statement and provide compliance cost information <br /> where indicated below. The costs for complying with the Trench Safety Act must be <br /> incorporated into this Project's base Bid . Certify this Statement in the presence of a <br /> notary public or other officer authorized to administer oaths . <br /> Certification <br /> 1 . I understand that the Trench Safety Act requires me to comply with OSHA <br /> excavation safety standards found in 29 C . F . R . s . 1926 . 650 Subpart P . I will comply <br /> with The Trench Safety Act and I will design and provide trench safety systems at all <br /> trench excavations in excess of five feet in depth for this Project . <br /> 2 . The estimated cost imposed by compliance with The Trench Safety Act will be : <br /> Dollars per linear foot of trench to be excavated . <br /> 3 . The estimated cost imposed by compliance with the Trench Safety Act will be : <br /> shoring used . Dollars $ per square foot of special <br /> 4 . The amount listed above has been included within the Base Bid . <br /> Certified : <br /> ( Contractor) <br /> By: <br /> (Signature) <br /> (Typed or Printed Name) <br /> STATE OF <br /> COUNTY OF <br /> The foregoing instrument was acknowledged before me this day of <br /> 200_ by of <br /> who is personally known to <br /> me or has produced as identification . <br /> Notary Public (affix sea ]) <br /> My Commission Expires : <br /> • END OF SECTION <br /> 00310-5 <br /> J 10]-029 12 Ind1 WM - Vero Lake Estales%Do menlslReportsTidding Contrad Specifiratiomi1 10 Bid Form.doc <br />