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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. IRC -1415 for INDIAN RIVER <br />BOULEVARD SIDEWALK FROM 37911 STREET TO 53rd STREET <br />2. This Sworn Statement is submitted by 1 %vyLu+ <br />(Legal Naffib of Entity Submitting Sworn State(Went) <br />hereinafter "BIDDER', h , The BIDDER's address is _ <br />BIDDER's Federal Em° toyer Idbritification Number (FEIN) is (nS, 1) -ZZ -4 LSI! L <br />3. My name ism fie. and my relationship to the BIDDER <br />(Print Name In ividual Signing) <br />is 2 " 10r <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 />Standards. <br />6. The BIDDER has allocated and included in its bid the total amount of $ x(06. <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 />U VA <br />a c.� <br />I ne aeterminatlon OT the appropriate meEnouts) uI GufllillidllUt-- l5 II IC GVIIlplul.0 clllu aulu <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 $ W <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 />FAPubllc WorksIENGINEERING DIVISION PROJECTS\1415-IR Blvd Sidewalk -37th Sl to 53rd SR1-Adrtdn\bid documentsWasler Contract Documents\00454 - Florida Trench - <br />Safely Act - REV 04-07.doc <br />