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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 . 0517 for Oslo Road Phase III <br /> Roadway Improvements ( 58th Avenue to 43rd Avenue ) <br /> 2 . This Sworn Statement is submitted b <br /> U J — ( Legal Name of ity bmitting Sworn Statement) <br /> hereinafter " BIDDER" . The BIDDER 's address is <br /> BIDDER 's Federal Employer Identifiodtion Number ( FEIN ) is <br /> 3 . My name is kyA L 11 and my relationship to the BIDDER <br /> ( Print N of Individual Signing ) <br /> is 2c,VL <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 . seg . 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 $ � , C) <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 /> 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 $ Z� <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 /> 07Public Works\ENGINEERING DIVISION PROJECTS\0517-OSLO ROAD 43rd AAvve o 58th Ave-Phase IIIVkdmim\bid documents\00454 - Florida Trench Safety <br /> Act - REV 04- <br /> 07 .doc — <br />