1999-338A - Laserfiche WebLink

Home Browse Search

SWORN 'STATEMENT UNDER THE FLORIDA �n TRENCH 'SAFETY ACT 1 THIS FORM MUST BE SIGNER BY THE BIDDER WHO WILL. BE RESPONSIBLE FOR THE ExcAVATION WORK ("BIDDER"), OR ITS AUTHORIZED REPRESENTATIVE, IN THE PRESENCE OF s0. NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS. 1. This Swom Statement is submitted with the [did No. for Round Island Oceanfro orfs C (Flerne of Project. end CoWW Pio. or Dstlwmbon, etc.) i- 2, This Sworn Statement is submitted b c��o- {legal name of entO $WNWM ewrxn sa1enwM) hereinafter "BIDDE R",business address is 9 _ LL, -s) BIDDER'S Federal Employer Identification Number (FEIN) is Lff] �)Qk - I 3. My name is TC. and my relationship L (PM nauna or It1rri fldual elgning) to the BIDDER is of/for the BIDDER i (Poaition or tela) I certify, through my signature at the end of this Swom Statement, that I am an authorized representative of the BIDDER. 4. The Trench Safety :standards that will be in effect during the construction of this Project are contained within (refer to the applicable Florida Statute(s) and/or OSHA Regulation(s) and include the "effective date" in the citation(s). Reference to and compliance with the applicable Florida Statute(s) and/or OSHA Regulation(s) is the complate and sole 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 tQ review or check the BIDDER'S compliance with the trench safety standards.. 5. The BIDDER assures the OWNER that it will comply with the applicable Trench Safety Standards and agrees to indemnify, defend and hold harmless the OWNER and ENGINEER, and any of their agents or employees, from any claims arising from the failure of the BIDDER to identify applicable standards or to comply with said standards. As specific consideration for the indemnification above, the OWNER agrees to give the BIDDER twenty-five dollars ($25.00), which the OWNER agrees is paid can behalf of all parties indemnified herein above. f. The BIDDER has allocated and included in its bid the total amount of $ 360 •0U. based on the linear feet of trench to be excavated over five (5) feet deep, for compliance with the applicable Trench Safety Standards and intends to comply with said standards by instructing the following specific method(s) of compliance on this Project; i 1R04CII STATE ME Kr I T-1