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SECTION 00454 -Sworn Statement under the Florida Trench Safety Act <br /> THIS FORD <br /> MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE <br /> FOR <br /> THE EXCAVATION WORK ("BIDDER"), OR ITS AUTHORIZED <br /> REPRESENTATIVE, <br /> IN THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO <br /> ADMINISTER OATHSW <br /> This Sworn Statement is submitted with Project No. 1210 for Sandridge Golf Course -- <br /> Drivinq Ran a Tee Renovations <br /> �Aa_J tet.i't �� �� r� '� � �� i' � �' F2. This Sworn Statement is submitted y �- -- -�.- <br /> �L gal Name of Entity Submitting Sworn Statement) <br /> hereinafter "BIDDER". The BIDDER's address is, <br /> w•^" ✓ L.,-r ..e2 Fy ' ''• ,^ti i �v a ! fi' :+-+ _ 4"�R Y ! ^`^ ::•- ~;x t••�9`4=7 <br /> Identification Number (FEIN)._is 5-,-q <br /> . <br /> BIDDER's Federal Employer <br /> r-- <br /> 3. My name isqic <br /> ��s� : • ' -- ~ and my relationship to the BIDDER <br /> ;ry (Print Name of individual Signind) <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 553.50 et.se . Florida Statutes and <br /> refer to the applicable Florida Statue(s) and/or OSHA Regulation(s) and include the <br /> re pp"effective date" in the citations). Reference to and compliance with the app licable <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 /> p Y <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 /> r'th theapplicable Trench Safety Standards, and intends to comply with said standards <br /> i <br /> by instituting the following specific method(s) of compliance on this Project: <br /> Y rte ; Y <br /> j y <br /> ll- <br /> r3 � `F s`4 l("?; ' �S:•[i Rif�Z-;_. r•�, '!- S� .. ���� � ..�k <br /> .2.H r• "O.y +..1 <br /> a i L •fix it ,�'i:S <br /> j <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 /> p Y <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 I -, <br /> -� on the square feet of shoring to be used for compliance with shoring safety <br /> based � g <br /> requirements and intends to comply with said shoring requirements by instituting the <br /> in specific methods of compliance on this Project: .� R _ <br /> following p method(s) ,� ����� <br /> 4L? <br /> 1x0454-Florida Trench Safety Act-REV D4-07.doc <br /> 00454-1 <br /> F:IPubIic WorksIENGINEER ING DIVIS 10N PROJECT U 21 Q-Sandridge Driving Range Tee RenavationlAdmimlbid dorumen€s=454--Florida Trench Safety Act-REV 04- <br /> 0 Tdac <br /> SmeadSoft Reprint Date:Monday,January 11,2016-09:21:50-OffidalDocuments:9069,Attachment Id 1,Page 29 <br />