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1 <br /> 1 SECTION 00454 - Sworn Statement Under the Florida Trench Safety Act <br /> I THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE <br /> 1 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 . 0391 for 27th Avenue Millinq & <br /> Resurfacing (Oslo Road to S . R . 60) <br /> 1 2 . This Sworn Statement is submitted by Ranger Construction Industries , Inc . <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter " BIDDER" . The BIDDER's address is _ <br /> 4510 Glades Cut - off Road , Fort Pierce , Florida 34981 <br /> I BIDDER ' s Federal Employer Identification Number ( FEIN) is 5 9 - 2 0 9 $ 5 5 2 <br /> 1 3 . My name is Scott Fowler and my relationship to the BIDDER <br /> ( Print Name of Individual Signing) <br /> ( <br /> IS Assistant Secretary / Chief Estimator <br /> li (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 /> 1 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 /> t Safety Standards . <br /> 5 . The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br /> ( Standards . <br /> t 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 /> r The determination of the appropriate method (s) of compliance is the complete and sole <br /> 1 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 $ / <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 : <br /> 1 <br /> 00454 1 <br /> 00454 - Florida Trench Safety Act - REV 04- 07 .doc <br /> ll - <br /> FAPuolic Works\ENGINEERING DIVISION PROJECTS10391 .27th Ave at 5th SI SWIAdrnWConlract Documenls=454 - Florida Trench Safely Act - REV 04 -07.doc <br />