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SECTION 00454 - Sworn Statement Under the Florida Trench Safety Act THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE FOR THE EXCAVATION WORK (" BIDDER") , OR ITS AUTHORIZED ~ REPRESENTATIVE, IN THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS . 1 . This Sworn Statement is submitted with Project No . 0016 & 0236 for 41St Street Roadway Improvements . 2 . T his Sworn Statement is Submitted by f 4K (Leg"91 Name of Entity Submitting Sworn Statement) 'Pa P�o�C 145'9 fps ror i plserue ! hereinafter " BIDDER" . The BIDDER's address is _ BIDDER' s Federal Employer Identification Number ( FEIN ) is Sq - 8o9 0 84*&Z 3 . My name is l crk SrawSe r and my relationship to the BIDDER (Print Name of Individual Signing) is NAw (Position or Title) { I certify , through my signature at the end of this Sworn Statement , that I am an authorized representative of the BIDDER. 4 . The Trench Safety Standards that will be in effect during the construction of this Project are contained within the Trench Safety Act Section 553 . 60 et. se4 . Florida Statutes and refer to the applicable Florida Statue (s ) and/or OSHA Regulation (s ) and include the I, "effective date" in the citation (s ) . Reference to and compliance with the applicable Florida Statute (s ) and OSHA Regulation ( s ) is the completeand sole responsibility of the i BIDDER . Such reference will not be checked by OWNER or. ENGINEER and they shall ow have no responsibility to review or check the BIDDER's compliance with the Trench j Safety Standards . 5 . The BIDDER assures the OWNER that it will comply with the applicable Trench Safety Standards and agrees to indemnify, defend and hold harmless the OWNER and ENGINEER , and any of their agents or employees , from any claims arising from the failure of the BIDDER to identify applicable standards or to comply with said standards . I: w. As specific consideration for the indemnification above , the OWNER agrees to give the BIDDER twenty-five dollars ( $ 25 . 00 ) , which the OWNER agrees is paid on behalf of all parties indemnified hereinabove . 6 . The BIDDER has allocated and included in its bid the total amount of $ Joao . of , based on the linear feet of trench to be excavated over five (5) feet deep , for - compliance with the applicable Trench Safety Standards , and intends to comply with said standards by instituting the following specific method (s ) of compliance on this Project : r 'ra The determination of the appropriate method (s ) of compliance is the complete and sole • responsibility of the BIDDER . Such methods will not be checked by the OWNER or ENGINEER for accuracy , completeness , or any other purpose . , The OWNER and ENGINEER shall have no responsibility to review or check the BIDDER' s compliance �. with the Trench Safety Standards . i ,r I 0016-00454 - Florida Trench Safety Act nn454 - 1