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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 -1927 for ROUND ISLAND <br />PARK EMERGENCY AND HEAVY EQUIPMENT BEACH ACCESS. <br />2. This Sworn Statement is submitted by DICKERSON FLORIDA, INC. <br />(Legal Name of Entity Submitting Sworn Statement) <br />"BIDDER". The BIDDER's address is 3122 N. 25TH ST. hereinafter <br />FT. PIERCE, FL 34946 <br />BIDDER's Federal .Employer Identification Number (FEIN) is 56-1327509 <br />3. My name is LARRY T. DALE 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 Safetv Act, Section 553.60 et.seg. 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 $ 1500.00 <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: SLOPE <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 $ N/A <br />based on the square feet of shoring to be used for compliance with shoring safety <br />00454 - Florida Trench Safety Act- REV 04-07 <br />00454-1 <br />Ft\Publlc WorkslENGINEERING DIVISION PROJECTS\1927 Round Island Beach Access11-Adm1nlBidsWd OocumentsWaster Contract Documenls\00454 - Florida Trench <br />Safety Act - REV 04.07.doc <br />