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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. 0206 for 5th Street SW / 43d <br /> Avenue Bridge Replacement and Intersection Improvements /� <br /> 2 . This -Sworn Statement is submitted by yj \ 6Hio`i�1+ Sgn " <br /> alymgoe <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter " BIDDER" . n _ Th , BID ER's addressis _ <br /> rC <br /> BIDDER's Federal Employer Identification Number (FEIN) i <br /> 3 . My name is Ri _C , \ pj J '�"t!0\, and my relationship to the BIDDER <br /> (Print N me of Individual Signing) <br /> is ,� ; dto <br /> (Position or Title) <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. se4 . 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 . o .A <br /> 6 . The BIDDER has allocated and included in its bid the total amount of $ / 600 <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: 5To e <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 . 00 <br /> 7) The BIDDER has allocated and included in its bid the total amount of $ / a O . <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: � � c a <br /> 00454 - Florida Trench Safety Act - REV 04-07 <br /> 00454 - 1 <br /> FAEngineeringZapital Projects\0206 5th ST SW & 43rd AVE Bridge Replacement & Roadway Improvements\CONTRACT BIDXO0464 - Florida Trench Safety Act - REV 04- <br /> 07.doc <br />