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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 . 0845 for Old Dixie Highway <br /> Sidewalk Improvements from 38'h Lane to 65th Street <br /> 2 . This Sworn Statement is submitted by GOo�SDn P*0ir1oi Jz0 (! . <br /> (Legal Name of Entity Tubmitting Sworn Statement) <br /> hereinafter " BIDDER" . The BIDDER's address is <br /> �o O aco RaaA cam, t L 3% Z9uo - <br /> BIDDER's Federal Employer ldenti ( cation Number ( FEIN ) is Sq - 2912065 <br /> 3 . My name is PHILIP ST1Fir-LjaR and my relationship to the BIDDER <br /> not Name of Individual Signing) <br /> IS rrP.& 06Ar <br /> (Position or Title) <br /> 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 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 - DO , <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 /> S UDS ►J� D r7CO 13 QVs g AS NCcQS:< Lo <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 $_ O0w ov <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 b instituting the <br /> following specific method ( s ) of compliance on this Project: 7RE� t-� 1)k 02 <br /> 00454 - Florida Trench Safety Act - REV 04-07 .doc <br /> 00454 - 1 <br /> F:\Public Works\ENGINEERING DIVISION PROJECTS\0B45-Dixie Hwy Sidewalk US1 _69th (LAP )Mmlm\bid documents\00454 - <br /> Florida Trench Safety Act - REV 04-07.doc <br /> w r <br />