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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 /> JT <br /> til X lOUSc C\CL Dollars S 6 t dco <br /> (Written) (Figures) <br /> 3. The amount listed above has been included within the Base Bid as listed on this Proposal Form. <br /> Certified: <br /> (Company actor) <br /> By: <br /> (P d tIPrincipal's Signature) <br /> l )o( , /Sc cs <br /> ( residenit/i Principal's Type or Print Name) r/ <br /> S to and subscribed to before me in Miami-Dade County, Florida on the / 14__ day of <br /> , 20 /x . <br /> Notary Public, State of Florida-at-Large: �- <br /> My Commission Expires: d� .2_0(.o'.;';.e„r, LEONA ANN ODEN <br /> °, -•: Notary Public-State of Florida <br /> �,,��U::/\ ; My Comm.(spites Aug 29.2018 <br /> Pc Commission • FF 118289 <br /> ,,,,,.••" Boroed Through National Natar sn. O126 <br />