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SECTION 00454 - 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 /> ] j REPRESENTATIVE, IN THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO <br /> ADMINISTER OATHS. <br /> 1 . This Sworn Statement is submitted with Project No. 9701 for <br /> RoadwaV Improvements to SR AIA and CR 510 <br /> (Name of Pro ect) , <br /> 2. This Sworn Statement is submitted by b <br /> cwbru <br /> (Legal Narrie of Entity Submitting Sworn Statement) <br /> hereinafter "BIDDER" The BIDDER'sr ss is <br /> 13loQS Std' O Qct t� �x c2 41cw roto VtS �- <br /> BIDDER's Federal Employer <br /> EmployerrIIdentification mber ( FEI ) is le OZ84 AVa1. . <br /> 3. My name is + tom loaz) and my relationship to the BIDDER <br /> (Privame of Individual Signing) <br /> is r2Sldlr► f - cN.I ler <br /> (Position orf <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 Statues) 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. l <br /> 6. The BIDDER has allocated and included in its bid the total amount of $ 1 000 <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 /> JI <br /> I <br /> The determination of the appropriate method(s) of compliance is the complete and sole <br /> � j 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 . Qo <br /> 7) The BIDDER has allocated and included in its bid the total amount of $ I C) � <br /> based on the square feet of shoring to be used for compliance with shoring safety <br /> JI j requirements and intends to comply with said shoring requirements by instituting the <br /> following specific method (s) of compliance on this Project : <br /> i00454 - Florida Trench Safety ACLdoc <br /> 00454 - 1 <br /> F'.\Public W ortts\Capifal Projects\SR AtA 8 CR 510 Torn Lanes_IRC-9701\31D DOCUMENTS 2006079\00454 - Florida Trench Safety Act doc Rev. 05/01 <br />