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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 /> I ADMINISTER OATHS. <br /> 1 . This Sworn Statement Is submitted with Project No. 0129 for <br /> ` KITCHING STATION TRAILHEAD. <br /> (Name of Project) <br /> 2 . This Sworn Statement Is submitted. by RA12T4 )A5Tevc,-f1yA , IroXv <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter "BIDDER". The BIDDER's address is _ <br /> I1IDIA4 RlVtAL SLLq> 2CZA y i3r4c 4 , r. . 321} (0O <br /> BIDDER's Federal Employer Identification Numbeso lbWs Sq - 19 3 Ru I N <br /> 3. My name is RRL f�74Pzro and my relationship to the BIDDER <br /> (Print Name of individual Signing) <br /> Is . R- rsic r4T <br /> ' . , (Position or Title) <br /> I certify, through my signature at the end of this Swom Statement, that I am <br /> an <br /> f4 authorized representative of the BIDDER. . <br /> ' 1 40 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.seq . 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 /> M 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 $ (� <br /> ' based on the linear feet of trench to be excavated over five 5 feet_dee .for compliance <br /> ( ) P• P <br /> with the applicable Trench Safety Standards, and intends to comply wittr-sald. 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 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 $ <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 - 1 004 <br /> 0219- 54 - Florida Trench Safety Act <br /> FAEnglneWnMCepltal Pn *ft1021941Ch1np Stabon Trailhead10219 IOtchingeContraot DOCS10219-00454 - Flodde Trench Safety Act doc Rev. 05/01 <br />