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74*w4 Rade Iadr�taetucg, %rc. <br />1,360 SW Old Dixie Hwy Suite 106 <br />Vero Beach, FL 32962 <br />SECTION 00454 - Sworn Statement Under the Florida Trench Safety Act <br />THIS FORM MUST BE SIGNED BY THE BIDDER WHO <br />FOR THE EXCAVATION <br />REPRESENTATIVE, IN THE <br />ADMINISTER OATHS. <br />WORK ("BIDDER"), <br />PRESENCE OF A NOTARY <br />WILL BE RESPONSIBLE <br />OR ITS AUTHORIZED <br />PUBLIC AUTHORIZED TO <br />1. This Sworn Statement is submitted with Project No. 0216 for 12th Street Sidewalk from <br />16th Ave to 11th PI <br />2. <br />3. <br />4. <br />5 <br />lei <br />This Sworn Statement is submitted by <br />ISIWO <br />auomaung %.-.)worn waiemeni) <br />BIDDER's Federal Employer Identification Number (FEIN) is (o50QL8-cA.),4a <br />My name is <br />of Individual Signing) <br />and my relationship to the BIDDER <br />is r 17, <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 />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.sep. 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 />The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br />Standards. 1 0 <br />The BIDDER has allocated and included in its bid the total amount of $`� ut , <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 />14 fVC4 1E- 0-P REPDSP <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 />7) The BIDDER has allocated and included in its bid the total amount of $ `moi t�2 Gt <br />based on the square feet of shoring to be used for compliance with shoring safety <br />requirements and intends to comply with said shoring requirements by instituting the <br />following specific method(s) of compliance on this Project: Y,F tr k�j3� <br />00454 - Florida Trench Safety Act <br />00454-1 <br />