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SECTION 00454 <br /> 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 . UCP #2229 for Indian River County <br /> Department of Utility Services — Operations Complex. <br /> 2 , This Sworn Statement is submitted by <br /> ( Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter " BIDDER" . The BIDDER 's address is <br /> BIDDER ' s Federal Employer Identification Number ( FEIN ) is <br /> 3 . My name is and my relationship to the BIDDER <br /> (Print Name of Individual Signing ) <br /> is <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 . 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 . <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 />