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SECTION 00454 - Sworn Statement Under the Florida Trench Safety Act <br /> r <br /> THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE <br /> FOR THE EXCAVATION WORK (" BIDDER"), OR ITS AUTHORIZED <br /> r REPRESENTATIVE, IN THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO <br /> ADMINISTER OATHS. <br /> 1 . This Sworn Statement is submitted with Project No . 9611 for CR512 . <br /> Phase IV Roadway Improvements 1 <br /> 2 . This Sworn Statement is submitted by � � � dl I t u f�G 4,, <br /> r (Legal Name of Entity Submitting orn Sta ement) <br /> hereinafter_ OCt IDDER" . Th IDDER'c address is _ <br /> 4W a1 . (e V J-0 k JC{(\ >Z Fby� fY�S � , wZl, c ( 5.3 <br /> BIDDER' s Federal Employer Identification Number ( FEIN ) is ( o S - O WcictCS . <br /> AW 3 . My name is D i t)U 6- 1 t ertcuZI n aT, and my relationship to the BIDDER <br /> qt C�(Print N e of Individu I Signi <br />_ IS �� `✓' t <br /> (Position or Title) <br /> r 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 ofp�Op <br /> r 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: 5tOoinlQ� , <br /> .. 77/[enlCi� f�X <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 $ Z <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 instituting the <br /> awl following specific method (s) of compliance on this Project: .t5e.071 1 /by <br /> •tr <br /> 00454 - Florida Trench Safety Act - REV 04-07.doc <br /> OWN 00454 - t <br /> F?EngineermglCapilal Projecta19611-CR 512 Wldening\9611 CR 512 PHASE MContraa OowmentsW0454 - Florida Trench Safety Act - REV 04-07.doc <br />