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SECTION 00454 - Sworn Statement Under the Florida 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 . 9920 9810-A 0545 for Roadway <br /> Improvements to 16`h Street from 74rh Avenue to 6 Avenue and 66h Avenue from 16`" <br /> Street to S. R. 60 <br /> 2 . This Sworn Statement is submitted by G � ot� � L L L. <br /> (LegalName of Entity Submitting Sworn Statement) <br /> -7316 INcsfpo -f Pl , w , P . l3 , FL - 33Li 13 <br /> hereinafter `BIDDER" . The BIDDER's address is <br /> BIDDER's Federal Employer Identification Number ( FEIN ) is Zo Iq z $h 7 c <br /> 3 . My name is f- • p-t0 u s s Or and my relationship to the BIDDER <br /> (Print Name of Individual Signing) <br /> IS Vi Cc Qua Sf • � � „ "r <br /> (Position or Title) <br /> I certify, through my signature at the end of this Sworn Statement, that 1 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 $ 5a o <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 /> e <br /> 1nDc . <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 b $ o . o 0 <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 : S I u rr <br /> 00454 - Florida Trench Safety Act <br /> 00454 - 1 <br /> F\Engineering\Capital Pmects19920- 15th St, 74th Ave to 66th Ave19920 Contract Documents 3 Specs00454 - Runde Trench Safety Act doc <br />