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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 Swom Statement is submitted with Project No. 0946 for 47th Street Roadway <br />Improvements east of US 1 to Terminus Point. <br />2. This Sworn Statement is submitted by eA,.,4o <br />(Legal Name of Entity Submitting Swom Statement) <br />hereinafter "BIDDER". The BIDDER's address is <br />1qq —nix;elaru& � ►�►�c,e �� 3�1 qi 4\ <br />BIDDER's Federal Employer Identification Number (FEIN) is ?1 \ b 9?, <br />3. My name is C1;Aot) (a,` ‘.\(o and my relationship to the BIDDER <br />(Print Name of Individual Signing) <br />is Dae.2_ <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 $ <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 />4'l tt, st"t4. ?``)-c c\ui q \rr acttu c,e.�-�S mss* o4- Ij e° —re -1"4^"''S <br />„u'S <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(s) of compliance on this Project: H'1t'` Wcy pp-'- <br />\ftcUQki p& %A A UAS ; `tc errr:l.'lt:ws O. 13+ <br />00454 - 1 <br />F:\Publlc Works\ENGINEERING DIVISION PROJECTS\0946-47TH Street (US1 to Terminus Point)»Admlm\bid documents \O946 Contract Documents\00454 • Florida Trench <br />Rom. Ari - RFV n4-n7.drr <br />00454 - Florida Trench Safety Act - REV 04-07.doc <br />