TRENCH_SAFETY_COMPLIANCE.docx

DOCX document 23 KB Posted

Attached to
Mack Bayou Road Pedestrian Improvements Phase I
Solicitation number
ITB 25-04
Issued by
Walton County, Florida

About this file

This is a Trench Safety Compliance sworn statement form required by the Board of County Commissioners of Walton County, Florida for the Mack Bayou Road Pedestrian Improvements Phase I project. The document mandates that bidders submit a notarized sworn statement certifying compliance with applicable trench safety standards, whether established under Florida Statute or OSHA standards, prior to bid submission. The statement requires the bidder's authorized officer to identify the specific trench safety standard that will govern the project, detail the appropriated budget per linear foot of trench excavation exceeding 5 feet in depth, and specify the budget allocated per square foot for shoring safety requirements. Bidders must describe the specific procedures and systems they will implement to achieve compliance. The statement must be executed before a notary public and accompanied by evidence that the bidder has reviewed all available geotechnical information and conducted necessary investigations and tests to adequately design the required trench safety systems.

The sworn statement requires bidders to acknowledge their indemnification obligation to hold harmless Walton County and the project engineer from any claims arising from failure to comply with applicable trench safety standards. This compliance document is a mandatory submission requirement for the Mack Bayou Road project, which involves approximately 10,845 linear feet of multi-use path construction and roadway improvements in Santa Rosa Beach, Florida, with a contract timeline of 180 days to substantial completion plus 30 additional days for punch list items. The project is partially funded through a State Funded Grant Agreement with the Florida Department of Transportation, and bid responses were due February 25, 2025, at 3:00 pm.

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Mack_Bayou_Road_Pedestrian_Improvements_Phase_I_(Addendum_#7_Revision).pdf PDF
Copy_of_MACK_BAYOU_ROAD_MULTI-USE_TRAIL_PHASE_1__Bid_Schedule_updated_.xlsx XLSX spreadsheet
UPDATED_Revised_Plans-Addendum.pdf PDF
Contract_No._25-04.pdf PDF
UNAUTHORIZED_ALIENS.pdf PDF
TRENCH_SAFETY_COMPLIANCE.docx DOCX document
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BID_FORM.docx DOCX document
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Text version

TRENCH SAFETY COMPLIANCE

BOARD OF COUNTY COMMISSIONERS,

WALTON COUNTY, FLORIDA

THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC BY AN OFFICER AUTHORIZED TO ADMINISTER OATHS.

1.This Sworn Statement is submitted with Bid No. __________ for _____________________________________________________________________
____________________________________________.

2. This Sworn Statement is submitted by _______________________________________ whose business address is ________________________________________________ and (if applicable) its Federal Employer Identification Number (FEIN) is _____________.

3. My name is ________________________________________________; I hold the position of ____________________________________ with the above entity.

4. The Trench Safety Standard that will be in effect during the construction of this Project is __________________________________________________________.

(refer to Fla. Statute or OSHA Standard)

5.The undersigned assures that the entity will comply with the applicable Trench Safety Standards and agrees to indemnify and hold harmless the County and ENGINEER, and any of their agents or employees from any claims arising from the failure to comply with said standard.
6.The undersigned has appropriated $__________________ per linear foot of trench to be excavated over 5' deep for compliance with the applicable standards and intends to comply by instituting the following procedures:

7. The undersigned has appropriated $__________________ per square foot for compliance with shoring safety requirements and intends to comply by instituting the following procedures:

8. The undersigned, in submitting this Bid, represents that he or she has reviewed and considered all available geotechnical information and made such other investigations and tests as he or she may deem necessary to adequately design the trench safety system(s) he or she will utilize on this Project.

____________________________________
(Signature)

Date: ______________________________

STATE OF FLORIDA

COUNTY OF ___________

________________________ who is personally known to me, the undersigned authority or who produced the following identification ____________________________, and who after first being sworn by me, executed the foregoing instrument by means of ☐ physical presence or ☐ online notarization on this _____ day of _____________________, 20____.

[SEAL] ________________________________

NOTARY PUBLIC

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