Florida_Trench_Safety_Form.pdf
PDF 96 KB Posted
- Attached to
- Palm Harbor Recreation Center Addition State and local contract opportunity
- Solicitation number
- 26-0011-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Florida Trench Safety Form and Disclosure Statement required for the Palm Harbor Recreation Center Addition project in Pinellas County, Florida. The document establishes compliance requirements under the Florida Trench Safety Act (Section 553.60 et seq., Florida Statutes), which incorporates Federal excavation safety standards from 29 C.F.R. Section 1926.650 Subpart P as the interim state standard. Bidders must acknowledge and comply with all applicable excavation and trench safety standards, consider available geotechnical data from the County and other sources, and accept sole responsibility for designing and implementing appropriate trench safety systems. The form requires bidders to disclose specific trench safety measures, units of measure (linear feet or square feet), quantities, unit costs, and extended costs for each safety measure employed during pipe installation. The General Contractor must complete this disclosure form as a procedural requirement of the Act, with failure to complete resulting in a non-responsive bid determination.
The contractor's disclosed trench safety costs do not limit the extent of their obligation to comply with applicable standards, and contractors must extend additional funds at no additional cost to Pinellas County if necessary to achieve full compliance. The County's acceptance of the bid does not constitute evaluation or determination that disclosed costs are adequate, nor does it relieve the contractor of sole responsibility for meeting all trench safety requirements. Bidders must provide company identification information, Federal Employee ID Number (FEIN), and contact details of their account representative. This form is provided for information purposes only and does not constitute payment authorization; any additional costs required for trench safety compliance beyond the disclosed amounts remain the contractor's responsibility under the contract terms.
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Text version
FLORIDA TRENCH SAFETY
FLORIDA TRENCH SAFETY ACT
CERTIFICATION AND DISCLOSURE STATEMENT
The undersigned acknowledges the requirements of the Florida Trench Safety Act (Section 553.60 et. seq. Florida Statutes).
A. The Bidder further acknowledges that the Florida Trench Safety Act, (the Act) establishes the Federal excavation safety standards set forth at 29 C.F.R. Section 1926.650 Subpart P, as the interim state standard until such time as the state of Florida, through its Department of Labor and Employment Security, or any successor agency, adopts, updates, or revises said interim standard. This State of Florida standard may be supplemented by special shoring requirements established by the State of Florida or any of its political subdivisions.
B. The Bidder, as Contractor, shall comply with all applicable excavation/trench safety standards.
C. The contractor shall consider the geotechnical data available from the County, if any, the Contractor's own sources, and all other relevant information in its design of the trench safety system to be employed on the subject Project. The Contractor acknowledges sole responsibilities for the selection of the data on which it relies in designing the safety system, as well as for the system itself.
D. The amounts that the Bidder has set forth for pipe installation includes the following excavation/trench safety measures and the linear feet of trench excavated under each safety measure. These units, costs, and unit values shall be disclosed solely for the purpose of compliance with procedural requirements of the Act. No adjustment to the Agreement Time or price shall be made for any difference in the actual number of linear feet of trench excavation, except as may be otherwise provided in these Contract Documents.
Trench Safety Measure (Description)
Units of Measure
(LF, SF)
Unit (Quantity)
Unit Cost
Extended Cost
1. $ $
2. $ $
3. $ $
4. $ $
5. $ $ For Information Only, Not for Payment Purposes $
FLORIDA TRENCH SAFETY
Bidder may use additional sheets as necessary to extend this form. Failure to complete the above may result in the bid being declared non-responsive.
A. The amount disclosed as the cost of compliance with the applicable trench safety requirements does not constitute the extent of the Contractor’s obligation to comply with said standards. The Contractor shall extend additional sums at no additional cost to the County, if necessary, to comply with the Act (except as otherwise be provided).
B. Acceptance of the bid to which this certification and disclosure applies in no way represents that the County or its representatives has evaluated and thereby determined that the above costs are adequate to comply with the applicable trench safety requirements nor does it in any way relieve the Contractor of its sole responsibility to comply with the applicable trench safety requirements.
Company Name
Name and Title
Address: Telephone/Fax
Federal Employee ID NO. (FEIN)
Email of Account Representative
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