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JSECTION 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 THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO <br /> ADMINISTER OATHS . <br /> 1 , This Sworn Statement is submitted with Project No . 0533 for Oslo Road (CR 606 ) <br /> Phase II Roadway Widening <br /> 2 , This Sworn Statement is submitted by a - C . <br /> (Legal Name of Entity Submitting SwornStatement) <br /> hereinafter " BIDDER" . The BIDDER's address is <br /> BIDDER's Federal Employer Identification Number ( FEIN ) is - b <br /> 3 . My name is L A 9q T. nA L6 and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> IS P��S I D E� t� T <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 /> 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 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 /> 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 $ 3 �� � � • 00 <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: 05LOPi <br /> Ir <br /> The determination of the appropriate method (s ) of compliance is the complete and sole <br /> 91 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 mpliance <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 Shdring - to 'be used for compliance wli h s bffng safety <br /> requirements and intends to comply with said shoring requirements by instituting the <br /> following specific method ( s) of compliance on this Project: <br /> 00454 - Florida Trench Safety Act - REV 04-07.doc <br /> 00454 - 1 <br /> F:\Public Works\ENGINEERING DIVISION PROJECTS\0533-Oslo Rd Phase 11 (43rd Ave to 271h Ave)\Admlm\bid documenls\00454 - Florida Trench SafetyAct - REV 04- <br /> 07 .doc <br />