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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 Trench Safety Act will be: <br /> 3C � e� c- Dollars $ 7,11—; C <br /> i (Written /n4tir-L�-/� (Fig&es) <br /> .a� �.�' .vr�,.,,m�i•''�l 7 � .,�- v�/ate, <br /> 3. The a ount listed above has been included within the Base Bid as listed on this roposal Form. <br /> Certified: Hypower, Inc /f <br /> (Company C'antr ctor) <br /> By: <br /> (Presiden�nsrparstignature) <br /> Eric Paul-Hus, Vice President <br /> (President/Principal's Type or Print Name) <br /> Sworn to and subscribed to before me in Miami-Dade County, Florida on the ' day of <br /> 20\4v. <br /> Notary Public, State of Florida-at-Large:_ <br /> My Commission Expires: <br /> s*pa nncon.ucamQUavurEzr99rszimssou,f <br /> EXPIRES:July 9,2019 <br /> Betted ihu Notary Putin Utenitm <br /> 00300-20/26 <br />