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1 <br />is <br />3. <br />0 <br />5. <br />6. <br />7) <br />SECTION 00454 = Sworn Statement Under the Florida Trench Safety Act <br />THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE FOR <br />THE EXCAVATION WORK ("BIDDER"), OR ITS AUTHORIZED REPRESENTATIVE, IN <br />THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS. <br />This Sworn Statement is submitted with Project No's. <br />This Sworn Statement is submitted by <br />"BIDDER". <br />(Legal Name of Entity <br />BIDDER's <br />BIDDER's Federal Employer Identification Number (FEIN) is <br />St <br />!Yi C-- <br />Subhitting Sworn Statement) <br />i --6, , hereinafter <br />address is <br />My name is Jird (Li fi d lna n _ and my relationship to the BIDDER <br />/� (Pjint Name of Individual Signing) <br />is L_Lnl -Crw f r1�4111Y1l <�IYlti f r, r— <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 />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.sea. 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 Florida <br />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 />The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br />Standards. <br />The BIDDER has allocated and included in its bid the total amount of $_ rdad <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: <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 with <br />the Trench Safety Standards. <br />The BIDDER has allocated and included in its bid the total amount of $ <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: <br />00454 - Florida Trench Safety Act <br />00454-1 <br />FAEngineering\Petition <br />Paving\0522 1 st Rd. <br />from 32nd Ave. to 35th Ave\Bid Documents\00454 - Florida <br />Trench Safety AcLdoc <br />