10-00454 - Trench Safety.pdf
PDF 187 KB Posted
- Attached to
- REBID - Floravon Shores Septic to Sewer
- Solicitation number
- 2026027
- Issued by
- Indian River County, Florida
About this file
This document is a Sworn Statement form under the Florida Trench Safety Act required for bidders responsible for excavation work on the Floravon Shores Septic to Sewer project in Indian River County, Florida. The project involves construction of a new gravity sanitary sewer system serving residential areas along 110th Place, 110th Street, and US Highway #1, encompassing approximately 893 linear feet of 8-inch sewer pipe, 5 manholes, 418 linear feet of 8-inch HDPE sewer directional bore, 19 service laterals, and related appurtenances. Bidders must execute this sworn statement in the presence of a notary public, certifying their understanding of and commitment to comply with applicable Trench Safety Standards contained within Section 553.60 et seq. of the Florida Statutes and relevant OSHA regulations. The statement must identify the bidder's legal name, address, Federal Employer Identification Number, and the authorized representative executing the form.
The bidder must allocate and include in their bid separate line-item costs for trench safety compliance based on linear feet of trench excavation exceeding five feet in depth and for shoring safety requirements based on square feet of shoring to be used. Bidders bear complete responsibility for determining appropriate compliance methods, obtaining and analyzing geotechnical information, and assessing subsurface site conditions. The owner and engineer assume no responsibility for reviewing, checking, or validating the bidder's compliance methods or the adequacy of allocated safety funding. Electronic bonds through SURETY2000 are accepted in addition to certified or cashier's checks. Prime contractors must execute a Non-Disclosure Agreement at least 14 days prior to the bid due date to access confidential project plans.
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Text version
SECTION 00454 – Sworn Statement Under the Florida Trench Safety Act
THIS FORM MUST BE SIGNED BY THE BIDDER WHO WILL BE RESPONSIBLE FOR
THE EXCAVATION WORK ("BIDDER"), OR ITS AUTHORIZED REPRESENTATIVE, IN
THE PRESENCE OF A NOTARY PUBLIC AUTHORIZED TO ADMINISTER OATHS.
1. This Sworn Statement is submitted with Project No.
for
2. This Sworn Statement is submitted by _______________________________________ (Legal Name of Entity Submitting Sworn Statement)
_____________________________________________________________, hereinafter “BIDDER”. The BIDDER’s address is
BIDDER’s Federal Employer Identification Number (FEIN) is .
3. My name is ________________________________ and my relationship to the BIDDER
(Print Name of Individual Signing) is ______________________________________________________________.
(Position or Title)
I certify, through my signature at the end of this Sworn Statement, that I am an authorized representative of the BIDDER.
4. The Trench Safety Standards that will be in effect during the construction of this Project are contained within the Trench Safety Act, Section 553.60 et.seq. Florida Statutes and refer to the applicable Florida Statue(s) and/or OSHA Regulation(s) and include the “effective date” in the citation(s). Reference to and compliance with the applicable Florida Statute(s) and OSHA Regulation(s) is the complete and sole responsibility of the BIDDER.
Such reference will not be checked by OWNER or ENGINEER and they shall have no responsibility to review or check the BIDDER’s compliance with the Trench Safety Standards.
5. The BIDDER assures the OWNER that it will comply with the applicable Trench Safety Standards.
6. The BIDDER has allocated and included in its bid the total amount of $_____________, based on the linear feet of trench to be excavated over five (5) feet deep, for compliance with the applicable Trench Safety Standards, and intends to comply with said standards by instituting the following specific method(s) of compliance on this Project: __________
The determination of the appropriate method(s) of compliance is the complete and sole responsibility of the BIDDER. Such methods will not be checked by the OWNER or ENGINEER for accuracy, completeness, or any other purpose. The OWNER and ENGINEER shall have no responsibility to review or check the BIDDER’s compliance with the Trench Safety Standards.
7. The BIDDER has allocated and included in its bid the total amount of $______________ based on the square feet of shoring to be used for compliance with shoring safety requirements and intends to comply with said shoring requirements by instituting the following specific method(s) of compliance on this Project: _______________________
The determination of the appropriate method(s) of compliance is the complete and sole responsibility of the BIDDER. Such methods will not be checked by the OWNER or ENGINEER for accuracy, completeness or any other purpose. The OWNER and ENGINEER shall have no responsibility to review or check the BIDDER’s compliance with the Trench Safety Standards.
8. The BIDDER, in submitting this bid, represents that it has obtained and considered all available geotechnical information, has utilized said geotechnical information and that, based on such information and the BIDDER’s own information, the BIDDER has sufficient knowledge of the Project’s surface and subsurface site conditions and characteristics to assure BIDDER’s compliance with the applicable Trench Safety Standards in designing the trench safety system(s) for the Project.
BIDDER: _________________________________
By: _____________________________________
Position or Title: ___________________________ Date: ____________________________________
STATE OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me by means of ☐ physical presence or ☐ online notarization, this day of ____________________, 20 , by
(name of person making statement).
(Signature of Notary Public - State of Florida) (Print, Type, or Stamp Commissioned Name of Notary Public)
☐ who is personally known to me or ☐ who has produced ______________________________ as identification.
* * END OF SECTION * *
SECTION 00454 – Sworn Statement Under the Florida Trench Safety Act
| This Sworn Statement is submitted with Project No: |
| for: |
| This Sworn Statement is submitted by: |
| BIDDER The BIDDERs address is: |
| Textfield: |
| BIDDERs Federal Employer Identification Number FEI: |
| My name is: |
| is: |
| The BIDDER has allocated and included in its bid t: |
| Textfield-0: |
| The determination of the appropriate methods of co: |
| The BIDDER has allocated and included in its bid t-0: |
| Textfield-1: |
| The determination of the appropriate methods of co-0: |
| By: |
| Position or Title: |
| Date: |
| STATE OF: |
| COUNTY OF: |
| physical presence or: Off |
| online: Off |
| notarization this: |
| day of: |
| 20: |
| by: |
| name of person making statement: |
| who is personally known to me or: Off |
| who has produced: Off |
| Textfield-2: |
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