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two, <br />L� <br />TRENCH SAFETY ACT <br />THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE <br />FOR THE EXCAVATION WORK ("BIDDER119 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. 0612 Wabasso Beach Park <br />Restoration. <br />2. <br />3. <br />F1 <br />5. <br />6. <br />This Sworn Statement is submitted by Ocean Gate General Contractors, <br />(Legal Name of Entity Submit <br />Sworn <br />hereinafter "BIDDER". The BIDDER's address is <br />2854 SE Federal Highway Stuart, FL 34994 <br />BIDDER's Federal Employer Identification Number (FEIN) is 651084099 <br />My name is Mark MacDonald and my relationship to the BIDDER <br />(Print Name of Individual Signing) <br />IS President <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.sea. 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. lo,000.00 <br />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 />Benching Trench Shielding and Trench Bnxec <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. 10,000.00 <br />7) The BIDDER has allocated and included in its bid the total amount of $ <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: Trench Boxing <br />Last Revised 12/2007 00454 -1 W abasso Beach Pk, Restoration <br />F:\Public Works\Cliff Suthard\Wabasso Beach ParkW Construction Bid Documents\Bid Documents as of 1-9-200801v 0 AS OF 1- <br />&2008\00454 - Florida Trench Safety Act.doe <br />