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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 Bid No . 2011012 for <br /> Quail Creek Subdivision <br /> 2 . This Sworn Statement is submitted byCk <br /> _ ( Legal Name f Entity Submitting Sworn Statement ) <br /> hereinafter " BIDDER " . The IDDER ' s address is <br /> P10JJ <br /> BIDDER ' s Federal Employer Identif' ation Number ( FEIN ) is i <br /> 3 . My name is -0 S4.- and my relationship to the BIDDER <br /> Print Name of Individual Signing ) <br /> 9 9 ) <br /> i S Yom' c% " t ` <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 <br />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 $ - ' <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 /> i <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 $ i <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, Methods ) of compliance on this Project : <br /> IN <br /> 00454 - Florida Trench Safety Act . doc <br /> 00454 - 1 <br /> F : \Engineering\Land Development Permits\Quail Creek PD\Bid -Contract Documents\00454 - Florida Trench Safety Act .doc <br />