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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. 1425 for SOUTH COUNTY PARK <br /> GENERAL USE FIELD. <br /> 2. This Sworn Statement is submitted by 6VF.%rc-Ff. aef S c4Nsirw� <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter 'BIDDER". The BIDDER's address is _ <br /> 'Jyo1 c'-ff'C7-Fwr4�l !7R'�r�y �`.-e+�srJ Ft,�r�:Lr.�.c-L FL 3�/9Y� <br /> BIDDER's Federal Employer Identification Number(FEIN) is <br /> 3. My name is 36,v and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> is rr,tA+6 e1v <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 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$ ho <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 /> 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$ goD <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 /> st 0tL%lJ a <br /> 00454-Florida Trench Safety Act-REV 04-07 <br /> 00454-1 <br /> FAPublic WorksIENGINEERING DIVISION PROJECTS11425-S County Park-General Use FieldlAdminlbid downentsWaster Contract Doaanenls100454-Florida Trench <br /> Safety Act-REV 04-07.doc <br />