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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 />._REPRESENTATIVE,. IN.._T_HEP_RESEN.CEO.F. A_NOT.ARY_PUBLIC__AUTH.ORIZED.Ta. <br />ADMINISTER -OATHS <br />This Sworn Statement is submitted with Project No. 1213 for Indian River County Public <br />S hooting Range — Skeet and Trap Facility Improvements (Phase I) <br />2. This Sworn Statement is submitted by A <br />jc-a e_. S.�r u'IL "4 <br />egal Name of Entity Submitting Sworn Statement) <br />jjhereinaftt?er , "BIDDER". The BIDDER's address is <br />yLi._) <br />B IDDER's Federal Employer Identification Number (FEIN) is r 331i bI° 5 o <br />• <br />3. My name is S &Urr- and my relationship to the BIDDER <br />/� (Print Name of Individual Signing) <br />is 1 (�e 5, :- <br />• <br />(Position or T tle) <br />Icertify, 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.seq. 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 />B IDDER. 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 />S afety Standards. <br />5. The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br />S tandards. <br />6. The BIDDER has allocated and included in its bid the total amount of $ C , <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 stapdards <br />by instituting the following specific method(s) of compliance on this Project: /vIA <br />• <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 />E NGINEER for accuracy, completeness, or any other purpose. The OWNER and <br />E NGINEER 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 $ <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 requiremep�ts by instituting the <br />following specific method(s) of compliance on this Project: /Cr tt <br />00454 - Florida Trench Safety Act - REV 04-07.doc <br />00454 - 1 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1213-IRC Shooting Range -Skeet & Trap Improvemnts & Hunters Train BldgWdmim\bid documents\Contract <br />•Documents\00454 - Florida Trench Safety Act - REV 04-07.doc <br />