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e <br />3 <br />i <br />J, <br />0 <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 />1. This Sworn Statement is submitted with Project No. 0205 for Bridge Replacement at Old <br />Dixie Hwy. over the South Relief Canal with Roadway and Drainage Improvements <br />2. This Sworn Statement is submitted by b I C ;c 6,01J rL,0 . J l I INC . <br />(Legal Name of Entity Submitting Swom Statement) <br />herei after "BIDDER". The ALIU D R's address is <br />BIDDER's Federal Employer Identification Number (FEIN) is <br />3. My name is l -A Q9 y _r. DALE and my relationship to the BIDDER <br />Tint Name of Individual Signing) <br />is �% C- s j bi:,;,N f <br />(Position or Title) <br />1 certify, through my signature at the end of this Sworn Statement, that 1 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. 00 <br />6. The BIDDER has allocated and included in its bid the total amount of $ 7a r <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: '5LE <br />D1 <br />L5 <br />s <br />0 <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 />The BIDDER has allocated and included in its bid the total amount of $ 500.00 <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: 5,(/r � i f'l L,E 1 � AJEC&5,50' <br />00454 - Florida Trench Safety Act.doc <br />00454-1 <br />FAEngineering\Capital Projacts10205 Old Dixie Highway Bridge over the South Relief Can& W205 Contract Documents 6 Spem\00154 • Florida Trench Safety Act.doc <br />