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SWORN STATEMENT UNDER THE FLORIDA TRENCH SAFETY ACT <br /> THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE <br /> RESPONSIBLE FOR THE EXCAVATION WORK (" BIDDER "), OR ITS <br /> AUTHORIZED REPRESENTATIVE, IN THE PRESENCE OF A NOTARY <br /> PUBLIC AUTHORIZED TO ADMINISTER OATHS, <br /> 1 . This Sworn Statement is submitted with Bid No . 2008000 for Moorings Club & Indian <br /> River County Seawall Repairs. <br /> '_ . This Sworn Statement is submitted by - <br /> � t ► yuVv� c � i �� i) � r1 a : , e 11✓�VUC'f1,E}YI 1... �- t_, <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter "BIDDER". ,The DER ' addr is ' <br /> 3 . My name isAUY�fULY1 and my relationship to the BIDDER <br /> t Name of lndividuaI Signing) <br /> is+sition <br /> or Title) 1 <br /> I certify, through my signature at the end of this Sworn Statement, that I am an authorized <br /> 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 Statutes 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 , <br /> 6 . The B DER has allocated and included in its proposal the total amount of <br /> S , based on the linear feet of trench to be excavated over five (5) feet <br /> deep , or compliance with the applicable Trench Safety Standards, and intends to comply <br /> with said standards by instituting the following specific method(s) of compliance on this <br /> Pro <br /> A r / <br /> Y <br /> Page 35 of 55 <br />