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SECTION 00454 - Sworn Statement Under the Florida Trench Safety Act <br />THIS FORM MUST BE SIGNED E3Y THE BIDDER WHO WILL BE RESPONSIBLE <br />FOR THE EXCAVATION WORK ("BIDDER"), OR ITS AUTHORIZED <br />REPRESENTAflVE, IN THE PRESENCE OF A NOTARY PUF3LC AUTH0RZED 10 <br />ADMINISTER OATHS. <br />1. This Sworn Staternent is submtted wth Pi:oject No. IRC -1362 for OLD DIXIE <br />HIGHWAY AND HIGHLAND DRIVE INTERSECTION IMPROVEMENTS. <br />2. This Sworn Statement is subriitted by Timothy Rose Contracting <br />(Legal Name of Entity Subn • ing Sworn Statement) <br />hereinafter "BIDDER", The BIDDER's address is <br />13OoSVvOld Dixie Hwy 5viteio6Vero Beach rL]2.g6� <br />B|OUER'nFederai Employer Identification Number (FEIN) is 65-0284242 <br />3 @y name is Timothy Rose and my relationship to the BIDDER <br />(Print Name ofIndividual Signing) <br />is President <br />(Position orTitle) <br />| onrUfv, through my siQnoture at the end of this Sworn Statement, that | 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 ed.sog' Florida Statutes and <br />refer to the applicable Florida Statue(s) and/o/ 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 shaU <br />have no responsibility to review or check the BiDDER'n compliance with the Trench <br />Safety Standards, <br />S: The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br />Standards. <br />O. The BIDDER has allocated and included in its bid the total amount of $ 1500'0» <br />based on the linear feet of trench to be excavated over five (5) feet deep, for compliance <br />with the applicable Trench Safety 8tandards, and intends to comply with said standards <br />by instituting the following specific method(s) of compliance on this Project: <br />Angle of Repose <br />The determination of the appropriate meUod(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 B|DDEF[n compliance <br />with the Trench Safety Standards. <br />7. The BIDDER has allocated and included in its bid the total amount af $ 1000'00 <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 />foliowing speciflc method(s) of cornpliance on this Project: <br />Sheet Piling <br />00454 - Florida Trench Safety Act - REV 04 07 <br />mwm 1 <br />F:1Public VVorks1ENGwEERIxsDIVIS/ON PROJECTS 362-OluDixie Hwy ����I-AM-N*31d DoctimontslMasler Contract Documunts100^^^'Florida Trench Safety <br />Act ' REV w.07.doc <br />