Laserfiche WebLink
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 a dre is _ <br />4W a1. (e V J-0 kf JC{(\>Z Fbyi iY�S �, wZl, c i 5.3 <br />BIDDER's Federal Employer Identification Number (FEIN) is <br />AW 3. My name is D i t)U 6- 1 t tcuzI n tTL 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 />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 />00454 - Florida Trench Safety Act - REV 04-07.doc <br />OWN <br />00454 -I <br />F?EngineermglCapilal Projects19611-CR <br />512 Wldening\9611 <br />CR <br />512 <br />PHASE MContraa OowmentsW0454 - <br />Florida <br />Trench <br />Safety Act -REV <br />04-07.doc <br />