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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. 1302 for Indian River Boulevard <br />Resurfacing (US 1 to 17th Street). <br />2. This Sworn Statement is submit e <br />y Ranger-ConstructiorrFndustries-Fnc. <br />(Legal Name of Entity Submitting Sworn Statement) <br />hereinafter "BIDDER". The BIDDER's address is <br />4510 Glades Cutoff Road, Ft. Pierce FL 34981 <br />BIDDER's Federal Employer Identification Number (FEIN) is 59-2098662 <br />3. My name is F. Scott Fowler <br />(Pnnt Name of Individual Signing) <br />is Vice President <br />• <br />and my relationship to the BIDDER <br />• <br />(Position or Ttle) <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 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. X / <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: /V <br />• <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 $ <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 in Muting the <br />following specific method(s) of compliance on this Project: <br />00454 - Florida Trench Safety Act - REV 04-07.doc <br />00454 - 1 <br />F:\Public Works\ENGINEERING DMSION PROJECTS\1302-IR Blvd Resurfacing (SCOP) US1 to 170 StlAdmim\bid documents\00454 - Florida Trench Safety Act - REV 04- <br />