Form FDACS-03433 "Fair Rides Affidavit of Compliance and Nondestructive Testing" - Florida

What Is Form FDACS-03433?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2020;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FDACS-03433 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-03433 "Fair Rides Affidavit of Compliance and Nondestructive Testing" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Consumer Services/Bureau of Fair Rides Inspection
FAIR RIDES AFFIDAVIT OF COMPLIANCE
AND NONDESTRUCTIVE TESTING
NICOLE “NIKKI” FRIED
Section 616.242(5)(b)4 and 5, (7), Florida Statutes
COMMISSIONER
Rule 5J-18.0012, Florida Administrative Code
Phone: 1-800-435-7352; Fax: (850) 410-3797
FairRides@FDACS.gov
AMUSEMENT COMPANY
STATE OF
________________
COUNTY OF ________________
Before me, the undersigned authority, personally appeared
, and being
duly sworn, states as follows:
1.
The affiant meets the qualifications required by Section 616.242(3)(p) or (q), Florida Statutes and Rule
5J-18.003, Florida Administrative Code, and:
a.
Affiant is a qualified inspector and my Florida Annual Inspection Authorization number is
_________________________, or
b.
Affiant is a Professional Engineer and my License # is __________________ in the State of
______________________.
2.
Affiant has personally inspected the amusement rides listed in the table on page 2 of this form on the date
indicated, and certifies that all of the amusement rides listed are in general conformance with the
requirements of Section 616.242, Florida Statutes, and Rule Chapter 5J-18, Florida Administrative Code,
as well as manufacturer required or recommended bulletins.
3.
Affiant certifies that, as a part of the annual permitting process, each amusement ride listed in the table
has undergone at least a visual nondestructive test for metal fatigue, conducted by a Level II or Level III
technician, unless exempt from nondestructive testing by Section 616.242(7)(d), Florida Statutes, and:
a.
All nondestructive tests are current.
b.
All nondestructive tests required or recommended by the manufacturer were conducted.
c.
Unless exempt each identified inspection point on the amusement ride has received at least a
visual nondestructive test, and that visual nondestructive test is adequate for the amusement ride
to be in general conformance with the requirements of Section 616.242, Florida Statutes, and
Rule Chapter 5J-18, Florida Administrative Code.
d.
For those amusement devices for which the manufacturer has not required or recommended a
visual nondestructive test, affiant has designated the required non-destructive test, the
component area and frequency or testing of the component to be tested.
e.
Maintenance plan/schedule has been reviewed and is current per ASTM F770-18 as incorporated
by reference in rule 5J-18.0011, F.A.C.
FDACS-03433 Rev. 07/20
Page 1 of 2
Florida Department of Agriculture and Consumer Services
Division of Consumer Services/Bureau of Fair Rides Inspection
FAIR RIDES AFFIDAVIT OF COMPLIANCE
AND NONDESTRUCTIVE TESTING
NICOLE “NIKKI” FRIED
Section 616.242(5)(b)4 and 5, (7), Florida Statutes
COMMISSIONER
Rule 5J-18.0012, Florida Administrative Code
Phone: 1-800-435-7352; Fax: (850) 410-3797
FairRides@FDACS.gov
AMUSEMENT COMPANY
STATE OF
________________
COUNTY OF ________________
Before me, the undersigned authority, personally appeared
, and being
duly sworn, states as follows:
1.
The affiant meets the qualifications required by Section 616.242(3)(p) or (q), Florida Statutes and Rule
5J-18.003, Florida Administrative Code, and:
a.
Affiant is a qualified inspector and my Florida Annual Inspection Authorization number is
_________________________, or
b.
Affiant is a Professional Engineer and my License # is __________________ in the State of
______________________.
2.
Affiant has personally inspected the amusement rides listed in the table on page 2 of this form on the date
indicated, and certifies that all of the amusement rides listed are in general conformance with the
requirements of Section 616.242, Florida Statutes, and Rule Chapter 5J-18, Florida Administrative Code,
as well as manufacturer required or recommended bulletins.
3.
Affiant certifies that, as a part of the annual permitting process, each amusement ride listed in the table
has undergone at least a visual nondestructive test for metal fatigue, conducted by a Level II or Level III
technician, unless exempt from nondestructive testing by Section 616.242(7)(d), Florida Statutes, and:
a.
All nondestructive tests are current.
b.
All nondestructive tests required or recommended by the manufacturer were conducted.
c.
Unless exempt each identified inspection point on the amusement ride has received at least a
visual nondestructive test, and that visual nondestructive test is adequate for the amusement ride
to be in general conformance with the requirements of Section 616.242, Florida Statutes, and
Rule Chapter 5J-18, Florida Administrative Code.
d.
For those amusement devices for which the manufacturer has not required or recommended a
visual nondestructive test, affiant has designated the required non-destructive test, the
component area and frequency or testing of the component to be tested.
e.
Maintenance plan/schedule has been reviewed and is current per ASTM F770-18 as incorporated
by reference in rule 5J-18.0011, F.A.C.
FDACS-03433 Rev. 07/20
Page 1 of 2
A
B
C
D
E
F
G
H
I
Date
Visual
Amusement Ride
Amusement
Amusement
Type of NDT
Component(s) of
Specify if NDT
Frequency of
NDT
Inspection
Name
Ride
Ride
Testing Conducted
Ride Tested
Required or
NDT Testing
Inspection
Date
Serial
USAID
(Specify if Required or
(Specify if Required
Recommended
Required or
Recommended by
or Recommended
Performed
Number
Number
by Manufacturer
Recommended
Manufacturer or Affiant)
by Manufacturer or
or Affiant
by Affiant or
Affiant)
Manufacturer
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Place Engineer’s
Seal Here
SIGNATURE OF AFFIANT _____________________________________________________
(if Engineer)
Sworn to (or affirmed) and subscribed to before me by means of ____ physical presence or
____ online notarization, this ________ day of _________________, 20_________
By (Print Name) _______________________________________________________________
Personally known ___ OR Produced Identification ___(Type)______________________________
NOTARY PUBLIC__________________________________ My commission expires____________
FDACS-03433 Rev. 07/20
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