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r <br /> r 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. 0201 for <br /> INDIAN RIVER DRIVE SOUTH SIDEWALK IMPROVEMENTS <br /> (Name of Project) <br /> 2 . This Sworn Statement is submitted by 1 Ctrtvty r <br /> c. _ �, D e rA 6 ") <br /> K\ (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter IfBIDDER" . The BIDDER's address is <br /> x300 Ay � C , oAp AUe_ r ft', -e- ADD I �7L �3a 9 3 9 - <br /> BIDDER s Federal Employer Identification Number ( FEW) is _.SJ - 39 -? y o so <br /> r <br /> 3 . My name is LaLu ( Lnu- -TCUAAf r Tr . and my relationship to the BIDDER <br /> (Pnnt, Name of Individual Signing) <br /> is eSI itis <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 /> .� 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 sep 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 /> r 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 $ I DOD . 00 <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 /> - <br /> itoDo , ot) _ 5 : nc_t.uet;- � r ( evtt na- i r In r� w� <br /> L' F ( fatn b � Ux jl ) NIkL. j � Sr rill 5 — t{ S — � <br /> r 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 /> r <br /> r <br /> r 00454 - 1 0201 -00454 - Florida Trench Safety Act <br /> FAEngineeringlCaplou Pr01ectSW201-03128-Intlian River Drive Sitlev,alk-South-Highiancl Drive SW10201 Indian River Drive South Sidewalk - Contract DoMQ201 -00454 - <br /> Flunda Trench Safely Act,doa Rev. ovol <br />