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710-010-22 <br />STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION UTILITIES <br />UTILIES <br />UTILITY WORK BY HIGHWAY CONTRACTOR AGREEMENT occ-11114 <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 />UTILITY: Indian River County <br />BY;(Signature) DATE: <br />(Typed Name: Joseph E. Flescher) <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 />P49 <br />