Laserfiche WebLink
SECTION 00454 - Sworn Statement Under the Florida Trench Safety Act <br />THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE FOR <br />THE EXCAVATION WORK("BIDDER"), OR ITS AUTHORIZED REPRESENTATIVE, IN <br />THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS. <br />This Sworn Statement is submitted with Bid No. 2021026 for <br />South Oslo Road WTP Improvements. <br />2. This Sworn Statement is submitted by TLC Diversified, Inc. <br />(Legal Name of Entity Submitting Sworn Statement) <br />hereinafter <br />"BIDDER". The BIDDER's address is 2719 17th Street East <br />Palmetto FL 34221 <br />BIDDER's Federal Employer Identification Number (FEIN) is 59-2513308 <br />3. My name is Dalas Lamberson and my relationship to the BIDDER <br />(Print Name of individual Signing) <br />is Vice 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 <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 Florida <br />Statute(s) and OSHA Regulation(s) is the complete and sole responsibility of the BIDDER. <br />Such reference will not be checked by OWNER or ENGINEER and they shall have no <br />responsibility to review or check the BIDDER's compliance with the Trench Safety <br />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 <br />$ 1,000.00 , based on the linear feet of trench to be excavated over five <br />(5) feet deep, for compliance with the applicable Trench Safety Standards, and intends to <br />comply with said standards by instituting the following specific method(s) of compliance <br />on this Project; <br />Trench Box <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 with <br />the Trench Safety Standards. <br />00454-1 157 <br />