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i • SWORN STATEMENT UNDER THE FLORIDA TRENCH SAFETY ACT THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE FOR THE. EXCAVATION WORD ("BIDDER"), OR ITS AUTHORIZED REPRESENTATIVE, IN THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS. 1. This Sworn Statement is submitted with the Bid No 9 8 for _ Shooting Rangy - itewor ------ (Nan* of Propel, and coftad NO od UesjM~.. etc � 2. This Sworn Statement is submittedby —LA, •-,I-, ,,/ r, , I L.L ] hereinafter "BIDDER",business address is BIDDER'S Federal Employer Identification Number (FEIN) is =_`1 J01d![Z ti3. My narne is �1rre"i�iti r"and my relationship _s fwm Cr r to the BIDDER is �I cvl' of If or1 the F3I0DER 2 14- ��C e� Lr(•{sl�'<' lacy fir' ;pwhon or (Akj I certify, through my signature at the end of this Sworn Statement, that I am an authorized representative of the BIDDER. A. The Trench Safety Standards that will be in effect during the construction of this Project are contained within L'11 f&, 'r 1 ../�f) (refer to the applicable Florida Statutes) an r OSHA Regulation(s) and include (fie '"effective date" in the cilation(s). Reference to and compliance with the applicabte Florida [ Stalvte(s) and/or OSHA Regulation(s) is the rtumplele and safe responsibility of the 'BIDDER. Such reference will not be checked by OWNER or ENGINEER for accuracy, completeness or any other purpose. The OWNER and ENGINEER shall have no responsibility to review or check the 81DDE R'S compliance with the trench safety standards. 5. The BIDDER assures the OWNER that it will compty with the applicable Trench Safety Standaids and agrees to indemnify, defend and held harrniass the OWNER and ENGINEER, and any of th,& agents or employees, from any claims arising frons the failure of the BIDDER tti idents aaoticablePanriarric nr tC WCn i.• �, .,r.r tem s��tia 6idr�cidrtis, As specdlc consideration for the indemnification above, the OWNER agrees to give the BIDDER twenty-five dollars - ($25.00), which the OWNER agrees is paid on behalf of all parties indemnified herein above. 6. The BIDDER has allocated and included in its bid the total amount of $ 2 , ,',. r, based on the irnear feet of trench to be excavated over five (5) feet deep, for comoance with the appficabie Trrdrx;l Safety Standards and intends to comply with said standards by instn.rcting the following specific methods) of compliance on this Project: TFyEHCH STATEMENT I - I