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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 Name : 4 t Street/Cooch Ditch Bridge <br /> +. Replacement & 11 � Street SW Paving and Drainage Project. <br /> 2. This Sworn Statement is submitted by S tt'tt� t�,�'1.1� <br /> - (Legal Nam of Entity Submitting Sworn Statement) <br /> hereinafter "BIDDER" . The BIDDER's address is <br /> 13Ca0 S.t.� <br /> BIDDER's Federal Employer Identification NumMr ( FEIN) is <br /> 3. My name is�IYYCU U3IwQ and my relationship to the BIDDER <br /> (Print a of Whividual Signing) <br /> IS <br /> (Position or Title) <br /> I certify, through my signature at the end of this Sworn Statement, that I am an <br /> r 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 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 /> 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 and agrees to indemnify, defend and hold harmless the OWNER and <br /> ENGINEER, and any of their agents or employees, from any claims arising from the <br /> failure of the BIDDER to identify applicable standards or to comply with said standards . <br /> As specific consideration for the indemnification above, the OWNER agrees to give the <br /> BIDDER twenty-five dollars ($25. 00) , which the OWNER agrees is paid on behalf of all <br /> parties indemnified hereinabove. 6D <br /> 6 . The BIDDER has allocated and included in its bid the total amount of $ast6 <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 /> S—��3e– c�n� 6P-�nef[yopa <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 /> 0209-00454 - Florida Trench Safety Act.doc <br /> 00454 - 1 <br /> F:1 Nineerinq%Capital PmJe0st020941h Street Bridge Over Conch Dit 0209. street Bridge Over Conch 07-20.0610209-00454 - Florida Trer SafetyA . mRev. 115101 <br />