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TRENCH SAFETY ACT COMPLIANCE STATEMENT <br /> Project Name: City of Sunny Isles Beach-Construction of Underground Utility <br /> Conduits <br /> Project Number: City Bid No. <br /> Project Location: Work is located in the street segments as shown on the Key Sheet of the <br /> Drawing Set, and is Collins Avenue and off Collins in the City of Sunny Isles, <br /> Florida. <br /> Instructions: <br /> Chapter 90-96 of the Laws of Florida requires all contractors engaged by the City of Sunny Isles Beach, <br /> Florida to comply with Occupational Safety and Health Administration Standard 29 C.F.R.s. 1926.650 <br /> Subpart P. All prospective contractors are required to sign the compliance statement and provide <br /> compliance cost information where indicated below. The costs for complying with the Trench Safety Act <br /> must be incorporated into this project's base bid as shown on page 1 of this document. <br /> Certify this form in the presence of a notary public or other officer authorized to administer oaths. <br /> CERTIFICATION <br /> 1. I understand that Chapter 90-96 of the Laws of Florida (The Trench Safety Act) requires me to <br /> comply with OSHA Standard, Standard 29 C.F.R.s. 1926.650 Subpart P. I will comply with the <br /> Trench Safety Act, and I will design and provide safety systems at all trench excavations in excess <br /> of five feet in depth for this project. <br /> 2. The estimated cost imposed by compliance with the TrenchTSafety Act will be: <br /> eve7M'inf Metan� Tt/-d . r>f1GTI 4--Boliars $ 3 25—c3, cr° <br /> (Written) 1 (Figures) <br /> 3. The amount li. aabove has been included within the Base Bid as listed on this Proposal Form. <br /> Certified: .4 -,_a, (Let- A <br /> .mpany ontractor <br /> By. <br /> (P sid nU Fnncipa gig an t regi ) <br /> fur 13(Pr Ider1U f�rinc js�pe�or P int Name � ' / <br /> S orn to and subscribed to before a in Mia i-%de Col ty, Florida on the j day of <br /> 1 µl Ll Aryl , 20 6 . <br /> Notary Public, State of = -. - .Of /lam M <br /> _ i <br /> ar �7' <br /> °9 NoW•.uE ,t�aioa • <br /> My Commission Expire- ... •? .. .,f._ • 6 2018 <br /> Commission a 0 121339 <br /> • <br /> 00300-20/26 <br />