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SECTION 00454 = Sworn Statement Under the Florida Trench Safety Act <br />THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE <br />FOR THE EXCAVATION WORK ("BIDDER"), OR ITS AUTHORIZED <br />REPRESENTATIVE, IN THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO <br />ADMINISTER OATHS. <br />1. This SwornStatement is submitted with Project No. 0604 for 12"' Street Sidewalk <br />from 43rd Ave to 27' Ave <br />2. This Sworn Statement is submitted by l 12.) AYA f cm iQq 0424A int �Td1L <br />(Legal Name of EnRy submitting Sworn Statement) <br />hereinafter "BIDDER The BIDDER's addr ss <br />Federal Employer <br />(FEIN) <br />is <br />3. My name is Ki �hP,l `t`s�L and my relationship to the BIDDER <br />(Print ame of individual Signing) <br />Is Al LA <br />(Position or TiNa) <br />I certify, through my signature at the end of this Sworn Statement, that I am an <br />authorized representative of the BIDDER. <br />4. The Trench Safety Standards that will be in effect during the construction of this Project <br />are contained within the Trench Safety Act, Section 553.60 et.seg. Florida Statutes and <br />refer to the applicable Florida Statue(s) and/or OSHA Regulation(s) and include the <br />"effective date" in the citation(s). Reference to and compliance with the applicable <br />Florida Statute(s) and OSHA Regulation(s) is the complete and sole responsibility of the <br />BIDDER. Such reference will not be checked by OWNER or ENGINEER and they shall <br />have no responsibility to review or check the BIDDER's compliance with the Trench <br />Safety Standards. <br />5. The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br />Standards. 0a <br />6. The BIDDER has allocated and included in its bid the total amount of <br />based on the linear feet of trench to be excavated over five (5) feet deep, for compliance <br />with the applicable Trench Safety Standards, and intends to comply with said standards <br />by instituting the following specific method(s) of compliance on this Project: lm <br />The determination of the appropriate method(s) of compliance is the complete and sole <br />responsibility of the BIDDER. Such methods will not be checked .by the OWNER or <br />ENGINEER for accuracy, completeness, or any other purpose. The OWNER and <br />ENGINEER shall have no responsibility to review or check the BIDDER's compliance <br />with the Trench Safety Standards. �. <br />7) The BIDDER has allocated and included in its bid the total amount of $ % b 0 k <br />based on the square feet of shoring to be used for compliance with shoring safety <br />requirements and intends to comply with said shoring requirements b instituting the <br />following specific method(s) of compliance on this Project: S' A o � lk <br />00454 - Florida Trench Safety Act <br />00454 = 1 <br />V4=. Inas.tnnlftardl l PMMrlfe106U42th St Sidewalk bnorove between 43rd Ave & 27th AveWd Documents%00454 - Florida Trench Safety Act.doc <br />