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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. 1137 for <br />Old Dixie Highway Resurfacing (From the I.R.F.W.C.D. North Relief Canal to 71St Street) <br />2. This Sworn Statement is submitted by � sj CLithii.c(± 6 <br />(Lega ame of Entity Submitting Sworn 5t tement) <br />hereinafter "BIDDE <br />\ 6, SW 0\ ,-N <br />BIDDER's Federal Employer <br />The BIDDER's address is <br />o .. �J<►2eacA _ (02.. <br />dentification Number (FEIN) is (.�� - 0 274242.. <br />3. My name is `A See <br />Print Name o ndividual Signing) <br />is 1)14 USA_ <br />(Position or Title) <br />and my relationship to the BIDDER <br />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 inclt.ide 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 $ , <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 />The BIDDER has allocated and included in its bid the total -amount of $ /.J <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 />FlWorks \ENGINEERING DIVISION PROJECTS Dixie Hwy Res 00458 IRF North Relief Canal to 71st St\Admim\bid documents contract Documents100454 - <br />Floridaorida Trench Safety Act - REV 04-07.doc <br />00454 - Florida Trench Safety Act - REV 04-07 doc <br />