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<br /> <br />00300 - 20/26 <br /> <br />TRENCH SAFETY ACT COMPLIANCE STATEMENT <br /> <br />Project Name: City of Sunny Isles Beach-Construction of Underground Utility <br />Conduits <br /> <br />Project Number: City Bid No. <br /> <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 /> <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 /> <br />Certify this form in the presence of a notary public or other officer authorized to administer oaths. <br /> <br />CERTIFICATION <br /> <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 /> <br />2. The estimated cost imposed by compliance with the Trench Safety Act will be: <br /> <br /> Dollars $ <br />(Written) (Figures) <br /> <br />3. The amount listed above has been included within the Base Bid as listed on this Proposal Form. <br /> <br />Certified: (Company Contractor) By: (President/ Principal's Signature) (President/ Principal's Type or Print Name) Sworn to and subscribed to before me in Miami-Dade County, Florida on the day of , 20____. <br /> <br />Notary Public, State of Florida-at-Large:________________________________ <br /> <br />My Commission Expires: _______________________