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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 />This Sworn Statement is submitted with <br />BEAUTIFICATION PROJECT PHASE II <br />This Sworn Statement is submitted by <br />Project No. IRC -1748 for 45LI STREET <br />Johnson -Davis Inc. <br />(Legal Name of Entity Submitting Sworn Statement) <br />hereinafter "BIDDER". The BIDDER's address is <br />863 S. Kings Hwy. Fort Pierce, FL 34945 <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 />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.sea. 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. dF <br />6. The BIDDER has allocated and included in its bid the total amount of $ om <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 s ecifict od(s) of compliance on this Project: <br />i A!c J' <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 />requirements and intends to comply with said shoring requirements by instituting the <br />following specific method(s) of compliance 9n 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 />00454 - Florida Trench Safety Act - REV 04-07 <br />00454-1 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1748 Gifford Neighborhood -45th Street Beautification Project Phase II\1-Admin\RE-bids0id Documents\Master <br />Contract Documents\00454 - Florida Trench Safety Act - REV 04-07.doc <br />