Laserfiche WebLink
a= <br />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. 97058 for <br />_ Oslo Road (CR606) / Lateral "J" Canal Bridge Replacement <br />(Name of Project) <br />2. <br />94 <br />4. <br />5. <br />on <br />This Sworn Statement is submitted by <br />hereinafter "BIDDER". <br />(Legal Name of Entity Submitting Sworn <br />The BIDDER's <br />BIDDER's Federal Employer Identification Number (FEIN) is <br />address is _ <br />My name is JO" ID ►L l_uX AS and my relationship to the BIDDER <br />(Print Name of Individual Signing) <br />Is ESIU T <br />(Position or Title) <br />I certify, through my signature at the end of this Sworn Statement, that I am an <br />authorized representative of the BIDDER. <br />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 <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 />The BIDDER assures the OWNER that it will comply with the applicable Trench Safety <br />Standards. <br />The BIDDER has allocated and included in its bid the total amount of $ if -W0 ,Db , <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 />A A tit . f cn � cc .s.e . i c 1 741 A 1 /. Q HVrVr-r1 A I r� a i)r i 51=4221 I J7N*TM AJ -?n CZ (" 01 1 <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 <br />with the Trench Safety Standards. <br />7) The BIDDER has allocated and included in its bid the total amount of $ IJE)o � <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 />00454 - Florida Trench Safety Act <br />00454-1 <br />F:\Public Works\Capital <br />Projects\Oslo <br />Road Lateral J\810 DOCUMENTS\00454 • Florida Trench <br />Safety Act.doc Rev. 05/01 <br />00454 - Florida Trench Safety Act <br />