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SECTION 00454 - SWORN STATEMENT UNDER THE FLORIDA TRENCH SAFETY ACT THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE FOR THE EXCAVATION WORK ( " BIDDER") , OR ITS AUTHORIZED REPRESENTATIVE , IN THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS . 1 . This Sworn Statement is submitted with Project No . 9205 for 4t' Street Widening from U . S . 1 to West of Old Dixie 2 , This Sworn Statement is submitted by 1 (Leg ame of Entity Submitting Sworn tement) hereinafter " BIDDER" T e BIDD ' s address is I ?)too SIA \ U ( O D )x l-ltct � BIDDER's Federal Employer Identification Number ( FEIN ) is 3 . My name is �� et) ,V, _ and my relationship to the BIDDER (P 'nt Na ' e of Indivl ualSigning) is PSI n ( osition orTitle) I certify, through my signature at the end of this Sworn Statement, that I am an authorized representative of the BIDDER. 4 . The Trench Safety Standards that will be in effect during the construction of this Project are contained within the Trench Safety Act Section 553 .60 et. seq . Florida Statutes and refer to the applicable Florida Statue(s ) and/or OSHA Regulation (s) and include the " effective date" in the citation (s) . Reference to and compliance with the applicable Florida Statute (s ) and OSHA Regulation (s ) is the complete and sole responsibility of the BIDDER. Such reference will not be checked by OWNER or ENGINEER and they shall have no responsibility to review or check the BIDDER's -compliance with the Trench Safety Standards . 5 , The BIDDER assures the OWNER that it will comply with the applicable Trench Safety Standards and agrees to indemnify, defend and hold harmless the OWNER and ENGINEER , and any of their agents or employees , from any claims arising from the failure of the BIDDER to identify applicable standards or to comply with said standards . As specific consideration for the indemnification above , the OWNER agrees to give the BIDDER twenty-five dollars ($25 . 00 ) , which the OWNER agrees is paid on behalf of all parties indemnified hereinabove . pq 6 . The BIDDER has allocated and included in its bid the total amount. of $ y� , based on the linear feet of trench to be excavated over five (5 ) feet deep , for compliance with the applicable Trench Safety Standards , and intends to comply with said standards by instituting the foil wing specific method ) of compliance on this Project: The determination of the appropriate method (s ) of compliance is the complete and sole responsibility of the BIDDER . Such methods will not be checked by the OWNER or ENGINEER for accuracy, completeness , or any other purpose . The OWNER and 00454 - Florida Trench Safety Act 00454 - 1 F:\Public Works\Capital Proiects\Fourth Street-Old Dixie-US I \CONTRACT DOCUMENTS\00454 - Florida Trench Safety Act.doc