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SECTION 8O454 - 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, IhJTHE PRESENCE C]FANOTARY PUBLIC AUTHORIZED TO <br />ADMINISTER OATHS. <br />1�This Sworn Statement is submitted with Project No. IRC -1305 for CR 512 <br />RESURFACING & SHOULDER WIDENING FROM MYRTLE STREET TO 125Lh <br />l This Sworn Statement issubmitted by —Comm'unity Asphalt Corp. <br />(Legal Name of Entity Submitting Sworn Statement) <br />hereinafter "BIDDER". The 8|DDER'o address is <br />2975 Industrial Boulevard Vero Beach, FL 32967 <br />. BIDDER's Federal Employer Identification Number (FEIN) is 59-2023298 <br />3. My name is Manuel Aguiar and my relationship to the BIDDER <br />(Print Name of Individual Signing) <br />is Corporate Vice 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 wAhin the Trench Safety Act, Section 553.60 et.seg. Florida Statutes d <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 itv4||comply with the applicable Trench Safety <br />Standards. <br />6. The BIDDER hes allocated and included in its bid the total amount of 8400 . <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 bo.curnplyvvith said standards <br />byinstituting the foUovvingepec{�onnethnd/m\ofconnp|ionCaonthis Project: <br />__________ <br />Trench Box <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, oonnp|ateneso, or any other purpose. The OWNER and <br />ENGINEER shall have no responsibility to review nrcheck the B|OOEF|'e compliance <br />with the Trench Safety Standards. <br />7. The BIDDER has allocated and included inits 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 nnethod(o)ofcompliance onthis Project: Sloping <br />oo*o4'Florida Trench Safety Act ' REV n* -0r <br />oo4s*- ` <br />r^Puumw"**s s/wsER/msowmmwpnoECTems05-Cnmzpes" woopuwyrtlesm`u=*st\A*rnirn\mu*oc"rn°ntsW"*°Contract ooc"="*s\0m^54-Florida <br />Trench Safety Act ' REV o4 -0r*= <br />