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SECTION 00454 - Sworn Statement Under the Florida Trench Safety Act THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE FOR THE EXCAVATION WORK ("BIDDER"), OR ITS AUTHORIZED REPRESENTATIVE, IM THE PRESENCE CIF A'NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS. 1. This Sworn Statement is submitted with Project No. IRC -1823 for JUNGLE TRAIL SHORLINE STABILIZATION PROJECT 2. This Sworn Statement is submitted by XGD Systems, LLC (Legal Name of Entity Summtirrg:`Saont Statement) hereinafter 'BIDDER". The BIDDER's address is 415 NW Flagler Ave, Stuart, FL 34994 BIDDER's Federal Employer Identification Number (FEIN) is 20-1254730 3. My name is Geoff Corlett and my relationship to the BIDDER (Print Name of Individual Signing) ys CFO tPositnan or Tine) I certify, through my signature at the end of this Sworn Statement, that I am an authorized representative of the BIDDER. 4. The Trench Safety Standards that will be in effect during the construction of this Project are contained within the Trench Safety Act, Section 553.60 et.seq. Florida Statutes and refer to the applicable Florida Statue(s) and/or OSHA Regulation(s) and include the "effective date" in the citation(s). Reference to and compliance with the applicable Florida Stats rtes) and OSHA Regtthation(s) is the complete and sole responsibility of the BIDDER. Such reference v et not be checked by OWNER or ENGINEER and they shalli have no responsibility to review or check the BIDDER°s compliance with the Trench Safety Standards. 5. The BIDDER assures the OWNER that it will comply with the applicable Trench Safety Standards. 6. The BIDDER has allocated and included in its bid the total amount of $ 0.00 based on the linear feet of trench to be excavated over five (5) feet deep, for compliance with the applicable Trench Safety Standards, and intends to corgply with said standards by instituting the ,following specific method(s) of coiropliance,on this Project: Not Applicable The determination of the appropriate method(s) of compliance is the complete and sole Pasponsthisiity of the BIDDER. Such methods will not be checked by the OWNER or ENGINEER for accuracy, completeness, or any other purpose. The OWNER and ENGINEER shall have no responsibility to review or check the BIDDER's compliance with the Trench Safety Standards. 7 The BIDDER has allocated and included in its bid the total amount of $ 0.00 based on the square feet of shoring to be used for compliance with shoring safety requirements and intends to comply with said shoring requirements by instituting the .fotlowing specific n ethxo i(s) of compliance on this Project: Not Applicable 00454 - Florida Trench Safety Act - REV 04-07 00454 - 1 F:\Public Works\ENGINEERING DIVISION PROJECTS11823 Jungle Trail Shoreline Stabilization Project (2018r.1-Admin\Bid Documents Master Contract Dowments\00454 - Florida Trench Safety Act - REV 04-07,doc