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SECTION 00454 - SWORN STATEMENT UNDER THE FLORIDA <br /> 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. 9219 for EAST GIFFORD <br /> STORMWATER IMPROVEMENTS . . <br /> T r <br /> 2. This Swom Statement is submitted by U 1 (� . r5an I— for I 6a , I�1' C <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter " BIDDER". The BIDDER's address is <br /> 5fi1 ta_ rr a F � 34997 <br /> BIDDER's Federal Employer Identification Number . ( FEIN ) is JT& - ! #327 rL� <br /> 3 . My name is �-- Gt. l� � a � and my relationship to the BIDDER <br /> (Pont Name of Individual Signing) <br /> is <br /> 1 (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. sea . 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 . o0 <br /> 6 . The BIDDER has allocated and included in its bid the total amount of $ 1 q � ' , <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 /> 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 $_ N <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 a Florida Trench Safety Act <br /> 00454 - 1 <br /> FA Puw1c work MMthm016nm ter "eetmGiBard Easacrostnu0on ContracAmde ing � Centrad Dooumentsadding 3 Contract D0C=Wb100454 - Florida Trendr Safety 63 <br /> Act.doc Rev. 05!01 <br />