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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 Sworn Statement is submitted with Project No 1330 for I.R.C. Go Line Transfer <br /> Hub. <br /> 2 This Sworn Statement is submitted by Barth Construction, Inc. <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter "BIDDER" The BIDDER's address is _ <br /> 1717 Indian River Blvd, Suite 202A, Vero Beach, FL 32960 <br /> BIDDER's Federal Employer Identification Number (FEIN) is 59-1931614 <br /> 3 My name is Phil Barth and my relationship to the BIDDER <br /> (Prittt Name of Individudl-Signing) <br /> is President <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 /> .:•: ':. ..-:l_a:Tnl,_4-/yam-.Piix—�.- :.:� .s'.Y... ;✓s.' <br /> Standards. -.- <br /> 6 The BIDDER has allocated:aand;:included:iii-its:bid the total amount of $ �b <br /> based on the linear feet"'of,t`rerich'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 /> 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. <br /> 00454-Florida Trench Safety Act-REV 04-07 <br /> 00454-1 <br /> P-\Bids\2015-2016 FY(2016000)\2016019-Goline Transfer Hub\Bid Docs\Word forms\00454-Florida Trench Safety Act-REV 04-07.doc <br />