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N <br />2 <br />7 <br />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 Project No. IRC -1325 for 58TH—AVENUE (FROM <br />NORTH OF 571H STREET TO 851" STREET) FULL DEPTH RECLAMATION, <br />This Sworn Statement is submitted by Timothy Rose Contracting <br />(Legal Name of Entity Submitting Sworn Statement) <br />, hereinafter <br />"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 />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 />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 />The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br />Standards. <br />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 />The BIDDER has allocated and included in its bid the total amount of $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 />following specific method(s) of compliance on this Project: <br />Sh <br />00454 - Florida Trench Safety Act - REV 04-07 (1) <br />00454-1 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1325 58th Avenue (57th St to CR 510) Roadway Inventory\I-Admin\Bids\Bid Documents\00454 - Florida <br />Trench Safety Act - REV 04-07 (1).doc <br />