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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: <br />(Typed Name: ) <br />(Typed Title: ) <br />Page 9 of 9 <br />DATE: <br />