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By: <br />Peter D. O'Bryan, Chairman <br />By: <br />Joseph A. Baird, County Administrator <br />APPROVED AS TO FORM AND LEGAL SUFFICIENCY: <br />By: <br />Dylan Reingold, County Attorney <br />Jeffrey R. Smith, Clerk of Court and Comptroller <br />Attest: <br />Deputy Clerk <br />(SEAL) <br />Designated Representative: <br />Name: Roland M. DeBlois, AICP <br />Title: Chief, Environmental Planning and Code <br />Enforcement Section <br />1801 27th Street <br />Vero Beach, FL 32960 <br />(772) 226-1258 <br />Facsimile: (772) 978-1806 <br />Page 7 of 7 <br />By: <br />(Contractor) <br />Attest <br />(CORPORATE SEAL) <br />Address for giving notices: <br />License No. <br />(Where applicable) <br />Agent for service of process: <br />Designated Representative: <br />Name: <br />Title: <br />Address: <br />Phone: <br />Facsimile: <br />(If CONTRACTOR is a corporation or a partnership, <br />attach evidence of authority to sign.) <br />59 <br />