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Bid No. 2019005/IRC-1760 <br /> SWORN STATEMENT UNDER THE FLORIDA TRENCH SAFETY ACT <br /> THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE FOR THE <br /> EXCAVATION WORK ("BIDDER"), OR ITS AUTHORIZED REPRESENTATIVE, IN THE <br /> PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS. <br /> 1. This Sworn Statement is submitted with Project No. IRC-1760 for <br /> VICTOR HART SR. COMPLEX DRAINAGE IMPROVEMENTS <br /> 2. This Sworn Statement is submitted by Guettler Brothers Construction, LLC <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> 4401 Whiteway Dairy Rd, Ft. Pierce, FL 34947 , hereinafter <br /> "BIDDER". The BIDDER's address is <br /> ----BIDDER's Federal-Employer Identification Number(FEIN) is 20-3608929 — - • — — <br /> 3. My name is Ren Guettler and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> is Manager <br /> (Position or Title) <br /> I certify, through my signature at the end of-this Sworn Statement, that I am an authorized <br /> representative of the BIDDER. <br /> 4. The Trench Safety Standards that will be in effect during the construction of this Project are <br /> contained within the Trench Safety Act, Section 553.60 et.seq. Florida Statutes and refer to the <br /> applicable Florida Statue(s) and/or OSHA Regulation(s) and include the "effective date" in the <br /> citation(s). Reference to and compliance with the applicable Florida Statute(s) and OSHA <br /> Regulation(s) is the complete and sole responsibility of the BIDDER. Such reference will not be <br /> checked by OWNER or ENGINEER and they shall have no responsibility to review or check the <br /> BIDDER's compliance with the Trench Safety Standards. <br /> 5. The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br /> Standards. <br /> • I <br /> 6. The BIDDER has allocated and included in its bid the total amount of $ t , based <br /> on the linear feet of trench to be excavated over five 5 <br /> ( ) feet deep, for compliance with the <br /> applicable Trench Safety Standards, and intends to comply with said standards by instituting the <br /> following specific method(s) of compliance on this Project: <br /> hat <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 ENGINEER <br /> for accuracy, completeness, or any other purpose. The OWNER and ENGINEER shall have no <br /> responsibility to review or check the BIDDER's compliance with the Trench Safety Standards. <br /> Page 23 of 39 <br />