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SECTION 00454 - Sworn Statement Under the Florida Trench Safety Act <br />THIS FORM MUST BE SIGNED BY THE BIDDER WHO VVILL 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 />1. This Sworn Statement is submitted with Project No. !RC -1628 for VERO LAKE <br />ESTATES 8511 STREET MILLINGS FROM 101St AVENUE TO 961`1 AVENUE. <br />2. This Sworn Statement is submitted by <br />Timothy Rose Contracting <br />(Legal Name of Entity Submitting Sworn Statement) <br />hereinafter "BIDDER". The BIDDER'S address is <br />1360 SW Old Dixie Hwy Suite 106 Vero Beach FL 32962 <br />BIDDER's Federal Employer Identification Number (FEIN) is 65-0284242 <br />3. My name is Timothy Rose 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.seq. 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. <br />6. The BIDDER has allocated and included in its bid the total amount of $ 1000.00 <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 specific method(s) of compliance on this Project: <br />Angle of Repose <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 on this Project: <br />N/A <br />00454 _ Florida Trench Safety Act - REV 04-07 <br />00454 -1 <br />F: Pubbc WortcsSENG>INEERING DIVISION PROJECTS11620-85th Street 96tli Ave to 101st Ave Roadway lmprovementsll •Admin\Bids\Bid DocumenlslMester Contract <br />Dacumen1s\00454 - Florida Trench Saltily Act - REV 04-07.doc <br />