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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 <br /> HE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO <br /> REPRESENTATIVE , IN T <br /> ADMINISTER OATHS . <br /> 1 . This Sworn Statement is submitted with Project No . 0217 for Powerline Road from C . R . <br /> 510 North to the Sebastian City Limits <br /> 2 . This Sworn Statement is submitted by J (Legal Name of EnecySubmitting sWmStatement) <br /> hereinafter " BIDDER" . The BIDDER' s �address is _ <br /> BIDDER' s Federal Empl yer Identifica''ti `on Num er (FEIN) is <br /> 3 . My name is P, lJ� �- and my relationship to the BIDDER <br /> (Print N of Individual $ignin� <br /> is \1 LC.� i' C�� L (] P <br /> (Position or Title) <br /> I certify , through my signature at the end of this Sworn Statement , that I am <br /> an <br /> authorized representative of the BIDDER. <br /> n effect during the construction of this Project <br /> 4 . The Trench Safety Standards that will be i <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 . <br /> 6 , The BIDDER has allocated and included in its bid the total amount of $.L <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 . U O <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 /> M requirements and intends to comply with said shoring requirements by instituting the <br /> following specific method (s) of compliance on this Project: <br /> _ :f2CeX0I <br /> 00454 - Florida Trench Safety Act <br /> _- 00454 - 1 <br /> RnwARirl nneumantsW0454 - Florida Trench Se}aW ACI.dOC <br />