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t <br /> 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 . 9219A for HARMONY OAKS <br /> MITIGATION PROJECT. <br /> 2 . This Sworn Statement is submitted by Oklawaha Farms , Inc . <br /> (Legal Name of Entity Submitting Sworn Statement) <br /> hereinafter " BIDDER" . The BIDDER's address is _ <br /> 9200 S Dadeland Blvd # 705 . Miami , FL 33156 <br /> BIDDER's Federal Employer Identification Number ( FEIN ) is 59 - 2835377 <br /> 3 . My name is Steven L . xi s i and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> is Vice President <br /> (Position or Title) <br /> 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. seg . 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 $ C <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 com fiance on this Project: <br /> COm� ltavir � u;. -h�, `TrPr, rh �� rour,. m /I (� nraa_ I <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 /> � 0 <br /> 7 ) The BIDDER has allocated and included in its bid the total amount of $ <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: U h P to ,41 <br /> 00454 - Florida Trench Safety Act <br /> 00454 - 1 HARMONY OAKS <br /> F:tPublic WorksUCelthMlSlommater ProjectsXHannony Oaks Mitigation Project\Construction Contract%Bidding and Construction Contract Documents100454 • Florida Trench <br /> Safely Act doc Rev. 05/01 <br />