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S� ECTION 00454 - Sworn Statement Urider the Florida Trench Safety Act <br /> THISP FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE <br /> FOR THE EXCAVATION WORK ( " BIDDER " ) , (DR ITS AUTHORIZED <br /> REPRESENTATIVE , IN THE PRESENCE OF A NOTARY (PUBLIC AUTHORIZED TO <br /> ADMINISTER OATHS , <br /> 1 . J his Sworn Statement is submitted with Project No . 1047 -2 for Indian River County <br /> Fairgrounds Phase 2 , Overflow and Vehicular Staging for Events of Fairgrounds <br /> 2 . i his Sworn Statement is submitted by "" " I TRACTOR SERVICE , INC . <br /> ( Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter " BIDDER " . The BIDDER ' s address is <br /> 4551 SE HAMPTON COURT , STUART , FL 34997 <br /> I:dDDER ' s Federal Employer Identification plumber ( FEIN ) is 65_0546351 —� <br /> 3 . loy name is DON R . MANCIL , JR . and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> 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 /> 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 inrlude the <br /> ' t7�ffective 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 /> heave no responsibility to review or check the BIDDER ' s compliance with the Trench <br /> `> afety Standards . <br /> 5 . The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br /> L <br /> tandards . <br /> 6 . The BIDDER has allocated and included in its bid the total amount of $ 50 . 00 <br /> teased 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 /> OPEN CUT PER OSHA STANDARD , TRENCH BOXES IF NEEDED PER OSHA STANDARDS . <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 . T he 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 : N / A <br /> 00454 - Florida Trench Safety Act - REV 04-07 . doc <br /> 00454 - 1 <br /> F: \Public wo-t. s\ENGINEER ING DIVISION PROJECTS11047-2 IRC Fairgrounds Overflow & Vehicular Staging Phase 2Wtlmin\bid documents\00454 - Florida Trench <br /> Safety <br /> Act - REV 047 . doc <br />