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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 . 0550 for 58TH Avenue Roadway <br /> Modifications <br /> 2 . This Sworn Statement is submitted by S . P, S , Co r- A-r -o . c,l-1nq TJ <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter" BIDDER" . The BIDDER's address is <br /> civic, h1-me .nCa ►1k 12L1a. c SL'Ci -i-e Ve, - , crC FL . adz <br /> BIDDER's Federal Employer Identification Number ( FEIN ) is _ 65 - 0 71r i-faf <br /> 3 . My name is t,- m 1n/ i A rno k1 n and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> Is . <br /> (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 /> 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 $ 50h. <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 /> sloPe <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 $ bJ <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 /> 00454 - Florida Trench Safety Act - REV 04-07.doc <br /> 00454 - 1 <br /> F:\Public Works\ENGINEERING DIVISION PROJECTS\0550 SR60&58th Ave Intersection Improvements (KHA)Wdmlm\Bid Documents\00454 - Florida Trench Safety Act - <br /> REV 04.07.doc <br />