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Bid No. 2018045/IRC-1502 <br />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 -1502 for <br />GIFFORD AREA STORMWATER PROJECT <br />2. This Sworn Statement is submitted by Johnson -Davis Inc. <br />(Legal Name of Entity Submitting Sworn Statement) <br />604 Hillbrath Drive. Lantana, FL 33462 , , hereinafter <br />"BIDDER". The BIDDER's address is <br />BIDDER's Federal Employer Identification Number (FEIN) is 59-1753888 <br />3. My name is Scott J. Johnson and my relationship to the BIDDER <br />(Print Name of individual Signing) <br />is President <br />(Position or Title) <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.seo. 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. A <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 methodis) 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 />Page 21 of 37 <br />