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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. 9705C for <br /> Oslo Road (CR 606 ) Phase I Roadway Widening <br /> (Name of Pro' <br /> 2 . This Sworn Statement is submitted byY1p .l- A�n �A �t�ZfLr <br /> (Legal Name of EnMy Submitting Sworn Statement) <br /> h a r "BIDDER" . The BID E 's address is <br /> BIDDER's Federal Employer a? !Identification Number (FEIN) is - j (g� q <br /> � <br /> 3 . My name is aAronl I '4Y15t and my relationship to the BIDDER <br /> ), r n (P . Name ofdnd ivid I Signing) <br /> IS `X. �,t.11 <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.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. <br /> 6 . The BIDDER has allocated and included in its bid the total amount of $ © D © <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 /> 2- ,A ?,5rarvSAPe `ii Jq (Wkes-e- uee�eQ� <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 $ a-.5 6 © p <br /> based on the square feet of shoring to be used for compliance withshoring safety <br /> requirements and intends to comply with said shoring requirements by instituting the <br /> following specific method (s) of compliance on this Project: e4p S-kee`�J� <br /> 00454 - Florida Trench Safety Act <br /> 00454 - 1 <br /> F.Tublic WorktiZapilal Projects\Oslo Road0slo Widening, Old Dixie to 27th Ave\CONTRACT DOCUMENT iI54 - Floritla Trench Safety A .Eoc Rev. 05101 <br />