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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 OATHSO <br /> 1 . This Sworn Statement is submitted with Project No .0744 for 8"' Street Sidewalk <br /> Improvements from U . S . 1 to 6`hAvenue . <br /> 2 . This Sworn Statement is submitted by Melvin Bush Construction , Inc <br /> (Legal Name of Entity Submitting Swom Statement) <br /> hereinafter " BIDDER". The BIDDER's address is _ <br /> 2748 SW Casella Street , Port St , Lucie , FL 34953 <br /> BIDDER's Federal Employer Identification Number (FEIN ) is 59 - 2950620 <br /> 3 , any name is Melvin Bush and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> is President <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 Regulations) 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 $ N / A <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: N /A <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 $ N /A <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 0"7.doc <br /> 00454 - 1 <br /> P%EVneMn9%Ce#tW Pmjec1s%0744 - 8th St Sldewalk hom U.5.1 lo 6M AvaW44 CONTRACT DOCUMENTSM454 - FlaWe TrwKh Safely Ad - REV 04-07.dot <br />