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SECTION 00454 - Sworn Statement Under the Florida Trench Safety Act <br /> MUST B SIGNED -. T <br /> THIS FORM E D BY HE BIDDER WHO WILL BE RESPONSIBLE <br /> FOR THE EXCAVATION WORK ' (" BIDDER"), OR ITS , AUTHORIZED` <br /> In I REPRESENTATIVE, IN THE PRESENCE :OF 'A Nm 1 , OTARY PUBLIC AUTHORIZED TO <br /> AIn <br /> DMINISTEROATHS. <br /> 1 . This SwornStatement is submitted with Project No. 1 , 131 for Indian River . Boulevard <br /> Resurfacing (41 ' Street to . 531 Street) <br /> 2 . Thi s Sworn Statement is submitted by ( >aM1c1rJ .`�'U l�'tSDhin <br /> ArII- ae , <br /> K In <br /> (Legal Name. of Entity Submitting Sworn S'ta ment) <br /> hereinafter "BIDDER" . The BIDDEIII m %7 IKs address is _ <br /> �} 3 . tri13c39tp <br /> me <br /> BIDDER'sFederal Employer identification Number (FEIN) is Sol -aria-za1 R <br /> 3 . My name is ' 3as Ari �e-�hP and my relationship to the BIDDER <br /> (Print Name of ndividuai Signing) <br /> Is . Jt riC� i�{ In I <br /> (Positlon or Title) <br /> t I certify, through my signature at the . end of this Sworn Statement; that I am an <br /> authorized representative of the BIDDER: <br /> II <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. sed . Florida Statutes and <br /> refer to the applicable. . Florida Statue(s) and/or OSHA Regulation (s) and include the <br /> "effective , date" ` in the citations) Reference to and ' compliance with the applicable <br /> Florida Statutes) and OSHA `Regulation (s) is the complete and ole 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. StandardsI men . <br /> 5 . The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br /> Standards . . <br /> 6 . 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 , r 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 /> 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 $� <br /> based on the square feet of shoring to be used for compliance with horing safety <br /> requirements and intends to comply with said shoring requirements by instituting the <br /> following speck method (s) of compliance on this Project. <br /> 00454 - Florida Trench Safety Act - REV 0"7.doc <br /> 00454 - 1 <br /> F.%PuWIC Woft%ENGINEERING DIVISION PROJECTSM3141k Blvd Rewftdng Mat St to Mrd St-SEE PROJ 09271AdrrdmrContrad Documents00454 • FWda Trench <br /> Safety Ad - REV W07.doc <br />