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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 /> 1 . This Sworn Statement is submitted with Project No. 0399 for NORTH COUNTY <br /> ` REGIONAL PARK, PHASE 2 <br /> t . <br /> (Name of PmJect) <br /> 2 . This Sworn Statement is submitted by B-Al2 + CoNslogT0 4 SNL <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter " BIDDER". The BIDDER's address is _ <br /> i lil ( t4U144 Rt01rt; $l,.Vo 0 2D2.A A/EQA emEACIA RL SZq& O <br /> - BIDDER's Federal Employer Identification Number ( FEIN ) is 59 - / IFS /& fy <br /> 3 . My name is Wim f14111:9 and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> t is 1 st t7t 4r 7 <br /> (Position or Title) <br /> 1 certify, through my signature at the end of this Sworn Statement, that I am an <br /> x 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 Safety Act, Section 553.60 et. seg . Florida Statutes and <br /> r .. 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 $ ! �"10Q . DO , <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 /> The determination of the appropriate method (s) of compliance is the complete and sole <br /> responsibility ER. Such methods will not be checked b the OWNER or <br /> p ty of the BIDDER, y <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 /> 7 ) The BIDDER has allocated and included in its bid the total amount of $ �. 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 /> 0399400454 - Florida Trench Safety Act.doc <br /> 00454 - 1 <br /> FAEngineeringkCapilal Projects%0399 North County Regional Park, Phase IIW399 Contract Docs%0399.00454 - Florida Trench Safety Act.doc Rev. 05/01 <br />