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- ci T l e i i `h a i t:,. Act <br />SECTION 00454 - Sworn St,tet-:��, -.. �- - . _ .. = i< . <br />-_= ',','-a0 WILL BE RESPONSIBLE <br />THIS FORM MUST BE SIGNED BY + -i_ = , - - - _ OR ITS AUTHORIZED <br />FOR THE EXCAVATION WORK �'I'`� ) <br />REPRESENTATIVE, IN THE PRESENCE OF ANOTARY PUBLIC AUTHORIZED TO <br />ADMINISTER OATHS. <br />1 This Sworn Statement is n submitted <br />mittto 45.t Street No. 0845B for Old Dixie Highway <br />Sidewalk Improvements, 38 Lane <br />2. This Sworn Statement is submitted by 110/V0.4 (gal N e of Entity Submitting Sworn Stat ent) <br />5a <br />hereinafter "BIDDER".0 T e BIDD�� address is <br />3COlaeI)IA id-twiStutt pVeiofI'ea hR-3 2423-1-2._ <br />BIDDER'S Federal�Employer Identification Number (FEIN) is ( Q <br />and my relationship to the BIDDER <br />3 My name is <br />(Print Name of <br />iS <br />I certify, through my signature at the end of this Sworn Statement, that (Position or Title) <br />am an <br />authorized representative of the BIDDER. <br />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 orbcheck the B DDER <br />e checked by OWNEs � comr p <br />liance ER with and <br />therench <br />they shall <br />have no responsibility to review <br />Safety Standards. <br />The BIDDER assures the OWNER that it will comply with the applicable Trend) 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,ompliance <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,r any <br />oncer �heck purpose. <br />he BIDDER'Os1comp ante <br />NER and <br />ENGINEER shall have no responsibilityo <br />with the Trench Safety Standards. the total amount of $ ��� <br />rt <br />7 TThe BIDDER has allocated and included in its bid <br />based on the square feet of shoring itbsaidused <br />shor ngcompliance <br />irementswith <br />bySinstit orinuing saf <br />the <br />ety <br />requirements and intends to comply with <br />following specific method(s) of compliance on this Project <br />00454 - Florida --_- <br />00454 - 1 <br />= =ublic Works\ENGINEERING DIVISION PROJECTS-•==== - <br />" Dixie Hwy Sidewalk (38th Ln - 45th St)Vadmim\bid doc:r.e, <br />--snob Safety Act - REV 04-07.doc <br />. 04-07 doc <br />--= - ---=--Florida <br />- r#.`S-,.� .''." ..`r�;l_r.a'zrx.e=¢si•5+'. rc''2s�,! <br />