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SECTION 00454 <br /> SWORN STATEMENT UNDER THE FLORIDA TRENCH SAFETY ACT <br /> • <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 . UCP #2229 for Indian River County <br /> Department of Utility Services — Operations Complex, <br /> 2 , This Sworn Statement is submitted by eoe .�.���-C , <br /> (Legal Name of Entity Submitting Sworn SL- ment) <br /> hereinafter " BIDDER" . The BIDDER's address is -3 zcp 43 �� A., r , <br /> V' 2 ►n t3 a-c k-1._ l✓ <br /> BIDDER's Federal Employer Identification Number ( FEIN ) is (o 4G <br /> 3 . My name is `Z S L .A1 and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> is ? rP SAZ+ P b. kt <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 . se . 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 . <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 : <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 /> IRC OPERATIONS COMPLEX 00454 — Florida Trench Safety Act <br /> 00454 - 1 <br />