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2010-265
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Last modified
2/22/2016 1:21:41 PM
Creation date
10/1/2015 1:26:43 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
10/19/2010
Control Number
2010-265
Agenda Item Number
12.I.1
Entity Name
Dickerson Florida Inc.
Subject
Contract 53rd Street Roadways Improvements
Area
IRFWCD Lateral H Canal to Indian River Boulevard
Project Number
0107
Bid Number
2011011
Supplemental fields
SmeadsoftID
9118
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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 THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO <br /> ADMINISTER OATHS . <br /> 1 . This Sworn Statement is submitted with Project No. 0107 <br /> Improvements IRFWCD LatRiver Boulevar <br /> eral H Canal to Indian for 53 `d Street Roadwa <br /> dl _ <br /> 2 . This Sworn Statement is submitted by ( < <br /> 3 C � I� (Le 00 <br /> Name of Entity S bmf Swom tateme t) <br /> hereinafter " BIDDER". The BIDDER ' <br /> address is _ <br /> BIDDER's Federal Employer Identificat1111111 io1111 n 11 11 1111111111111111111111111 <br /> Number ( FEIN ) is <br /> 3 . My name is .. I� .R ` �� <br /> Print Name of Individual Signing) and my relationship to the BIDDER <br /> is <br /> (Position or Title) <br /> I certify, through my signature at the end of this Sworn Statement, that I am <br />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 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 /> 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 $ _ 6 I'll 9 <br /> Jr <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 /> SLo�� <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 $-S/5 . 00 <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 ,i stituting the <br /> following specific method (s ) of compliance on this Project: <br /> 00454 - Florida Trench Safety Act - REV 04-07. doc <br /> F:\EngineerinoCapital ProjectsW107-53rd St, 58th Ave-US #1 \Conlrad Documentts100445 - Florida Trench Safety Act - REV 04-07 .doc <br />
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