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STATE OF MOROA DEPARTMENT OF TRANSPORTATION <br />SECURITY INSTRUMENT RECEIPT <br />APPLICATION NUMBER: <br />WO -00-20 <br />SYSTEMS PLANNING <br />0M <br />I PARI l,' PERMrrTEE INFORMATION I <br />Name of Applicant Indian, River County..Public Works - Mr.. James Ennis P.E. <br />Naive of Authorized Agent N/A <br />Name oforganmatlon: . Indian River County <br />Mailing Address: _ 1801 27th Street: Vero Beach, FL 3240 <br />-reiephone: 772-226-1.221 <br />Consultant/Engineerlar Project Manager MBV Engineering, Inc - Mr. Aaron Bowies P.E. <br />Address' 1835 20th Street Vero :Beach 'FL 32060 <br />Telephone: 772-58MO35 FAX Mobile- Phone. etc 772-77$=3617 <br />PART 2: ESTIMATED -COST OF CONSTRUCTION ON RIGHT -Of -WAY, <br />COSTEESTIMATES $ $10.4,52-35 GElyse <br />PLEASE ATTAWALt CALCUUX7{oNS• <br />Estimated by: Mr. Aaron .Bowles, P.E., 5531 <br />NAME (PriMBd of TYPeq (AFFllt p e g3. <br />S <br />NOTE: MLsst be estimated by a: onat.Eflgi registee eZI in the staff br Florida <br />STATE +OF <br />Srgi3ture <br />- -- a. <br />PART 3,: SECURITY INSTRUMENT RECEIPT CERTIFICATION <br />Receiaed:by Florida Department of Transportation: <br />Date. Person Acoev" Signature <br />Performanoe Bond returned by Certified Mail (Receipt of Certified Mail Attached): <br />Date Person Processing Signature <br />PART 4: INSPECTIOK VERIFICATION <br />Signature of Staff Datta:, <br />ATTACH INSPECTION DOCUMENTATION <br />Approved <br />2018-A-490-01 0 <br />Mesa Harden <br />5/8/2018 <br />