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SECTION 00454 - Sworn Stately <br /> :.0 l l'�11t:Cd Safety Rri t <br /> - - _ , <br /> THIS FORM MUST BE SIGNED BY T = = _- - %.-JO WILL BE RESPONSIBLE <br /> OR ITS AUTHORIZED <br /> FOR THE EXCAVATION WORK <br /> REPRESENTATIVE, IN THE PRESENCE CF A NOTARY PUBLIC AUTHORIZED TO <br /> ADMINISTER OATHS. <br /> �. This Sworn Statement is h is to 45�t StPeetect No 0845B for Old Dixie Highway <br /> Sidewalk improvements, 38 an <br /> -l� Vt �Entity <br /> -1 iii C. tvy <br /> 2. This Sworn Statement is submitted by 1 Yvvv e Submitting Sworn Stat ent) <br /> (Legal N <br /> hereinafter "BIDDER".- T-b e BIDDER's address is <br /> BIDDER's Federal Employer Identification Number (FEIN) is ^�" OZ� <br /> 3, My name is--- and my relationship to the BIDDER <br /> � <br /> (Print Name of ividual Signin <br /> is <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.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 OWNEor s compor liance eENGINEER <br /> the Trench <br /> they shall <br /> have no responsibility to review check the BIDDER <br /> Safety Standards. <br /> = The BIDDER assures the OWNER that it will comply with the applicable Trenc Safety <br /> Standards. <br /> g. 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, 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 $ h�orinJ safety <br /> based on the square feet of shoring to be used for compliance with g <br /> requirements and intends to comply with said shoring requirements by instituting the <br /> following specific method(s) of compliance on this Project: <br /> 34-07.doc <br /> 00454-Florida - `-- <br /> 00454-1 _-,-Florida <br /> _ public Works\ENGINEERING DIVISION PROJECTS ','d Dixie Hwy Sidewalk(38th Ln-45th St)\Admlm\bid docu <br /> _ --=-ch Safety Act-REV 04-07.doe <br />