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IRC -1639 <br />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 />1. This Sworn Statement is submitted with Project No. IRC -1639 for 69TH STREET FROM <br />66TH AVENUE TO SRS/US-1, RESURFACING <br />2. This Sworn Statement is submitted by Timothy Rose Contracting, Inc. <br />(Legal Name of Entity Submitting Sworn Statement) <br />hereinafter <br />"BIDDER". The BIDDER's address is <br />825 8th Street, Vero Beach, FL 32962 <br />BIDDER's Federal Employer Identification Number (FEIN) is 65-0284242 <br />3. My name is Zachary Rose and my relationship to the BIDDER <br />(Print Name of Individual Signing) <br />is Vice Presdent <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.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 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 $ 750.00 , <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 />Trench Box - 100 SF - $7.50 per SF <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 />7. The BIDDER has allocated and included in its bid the total amount of $ 1,000.00 <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 />Angle of Repose <br />Florida Trench Safety Act - REV 04-07 - 00454 -1 <br />FAPubIIc WorkskENGINEERtNG DIVISION PROJECTS11639 69th Street 66th Avenue to US -1 Resurfacing (SCOP)11-Admin\Bids%Bid Documents - AdvadisementtDIV <br />0_1_Bidding Documents - 20210824.docx <br />