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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION BioIL1TIE2 <br /> UTILITY WORK BY HIGHWAY CONTRACTOR AGREEMENT oGc ur E4 <br /> (AT UTILITY EXPENSE) <br /> appendix entitled Changes to Form Document. <br /> You MUST signify by selecting or checking which of the following applies <br /> ❑ No changes have been made to this Form Document and no Appendix entitled "Changes to Form <br /> Document' is attached <br /> ® No changes have been made to this Form Document, but changes are included on the attached Appendix <br /> entitled "Changes to Form Document." <br /> IN WITNESS WHEREOF, the parties hereto have executed this Agreement effective the day and year first written. <br /> �'�0 ht MASS•. <br /> UTILITY: Indian River County :��J`,� /�^�• <br /> BY: Si nature :�;. DATE: 1 in er 20, 2016 <br /> (Typedame: Joseph E. Flescher) `•'A�yFRCOUR��E' <br /> (Typed Title: Chairman of Board of County Commissioners) <br /> Recommend Approval by the District Utility Office <br /> BY: (Signature) DATE: <br /> FDOT Legal review <br /> BY: (Signature) DATE: <br /> District Counsel <br /> STATE OF FLORIDA <br /> DEPARTMENT OF TRANSPORTATION <br /> BY: (Signature) DATE: <br /> (Typed Name: Stacy Miller, P.E. ) <br /> (Typed Title: Director of Development) <br /> FEDERAL HIGHWAY ADMINISTRATION (if applicable) <br /> BY: DATE: <br /> (Typed Name: ) <br /> (Typed Title: ) <br /> Page 9 of 9 <br />