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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 Sworn Statement 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 .) AYAf Cm im 0424A 62 �TJ1L <br /> (Legal Name of EnRy submitting Sworn Statement) <br /> hereinafter " IDD " . The BIDDER's adds s is _ <br /> BIDDER's Federal Employer Identification Number ( FEIN ) i <br /> 3 . My name is � i �-YIP� �JM 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 <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 by, instituting the <br /> following specific method (s) of compliance on this Project: S' A o <br /> 00454 - Florida Trench Safety Act <br /> 00454 - 1 <br /> V4=. Inas.tnnlr arsllmi PrnhvAft1060442th St Sidewalk bnorove between 43rd Ave & 27th AveWd Documents=454 - Florida Trench Safety Ad.doc <br />