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Kerns Construction & Property Management Cori <br />Bid No. 2020053/IRC-1855 <br />SWORN STATEMENT UNDER THE FLORIDA TRENCH SAFETY ACT <br />THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE FOR THE <br />EXCAVATION WORK ("BIDDER"), OR ITS AUTHORIZED REPRESENTATIVE, IN THE <br />PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS. <br />This Sworn Statement is submitted with Project No. IRC -1855 for <br />ROSELAND COMMUNITY CENTER BUILDING & SITE IMPROVEMENTS <br />This Sworn Statement is submitted by Kerns Construction & Property Management Cor <br />(Legal Name of Entity Submitting Sworn Statement) <br />hereinafter <br />"BIDDER". The BIDDER's address is _ <br />1680 SW Bayshore Boulevard. Suite 226, Port St. Lucie. FL 34984 <br />BIDDER's Federal Employer Identification Number (FEIN) is 30-0449688 <br />3. My name is Daniel L. Muschweck and my relationship to the BIDDER <br />(Print Name of Individual Signing) <br />is It's President <br />(Position or Title) <br />I certify, through my signature at the end of this Sworn Statement, that I am an authorized <br />representative of the BIDDER. <br />4. The Trench Safety Standards that will be in effect during the construction of this Project are <br />contained within the Trench Safety Act, Section 553.60 et.sea. Florida Statutes and refer to the <br />applicable Florida Statue(s) and/or OSHA Regulation(s) and include the "effective date" in the <br />citation(s). Reference to and compliance with the applicable Florida Statute(s) and OSHA <br />Regulation(s) is the complete and sole responsibility of the BIDDER. Such reference will not be <br />checked by OWNER or ENGINEER and they shall have no responsibility to review or check the <br />BIDDER's compliance with the Trench 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 $ 1,500.00 , based <br />on the linear feet of trench to be excavated over five (5) feet deep, for compliance with the <br />applicable Trench Safety Standards, and intends to comply with said standards by instituting the <br />following specific method(s) of compliance on this Project: <br />Benched and/or Sloped Excavations <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 ENGINEER <br />for accuracy, completeness, or any other purpose. The OWNER and ENGINEER shall have no <br />responsibility to review or check the BIDDER's compliance with the Trench Safety Standards. <br />Page 23 of 45 <br />