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I . <br /> 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 /> NEW 1 . This Sworn Statement is submitted with Project No. 1102 for Old Dixie Highway <br /> Sidewalk Improvement from 8t' St. to S . R . 60 . <br /> 2 . This Sworn Statement is submitted by tiSSE <br /> (Legal Name of E 'ty S mitting Sworn Statement) <br /> r <br /> hereinafter " BIDDER" . Th BIDD R's address is <br /> 3100 � 0 o 3 4z =k <br /> BIDDER's Federal Employer Identifirdlicn Number (FEIN) is FS � a <br /> 3 . My name is IT y\,\ se, and my relationship to the BIDDER <br /> iq1tvarne of Individual Signing) <br /> Is <br /> (Position or Tide) <br /> I certify, through my signature at the end of this Sworn Statement, that I am an <br /> IF <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. seci . 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 /> 1 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 $ � 60 , <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 followin specific meth (s of compliance on this Project: <br /> -- <br /> 444 <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 instituting the <br /> following specific method ( of compl 'ance on this Project: <br /> 00454 - Florida Trench Safety Act - REV 04-07.doc <br /> 00454 - 1 <br /> F:\Public Works\ENGINEERING DIVISION PROJECTS\1102.Old Dixie Hwy Swk 8th St to SR 604 AP\Admim\bid doaxnentsWaster Contract Documenls\00454 • Florida <br /> Trench Safety Act - REV 04-07.doc <br />