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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form No. 710-010-56 <br />UTILITY DESIGN BY FDOT CONSULTANT AGREEMENT UTILITIES <br />(AT UTILITY EXPENSE) 11/14 <br />If to the UAO: <br />Vincent Burke, P.E., Utilities Director, Indian River Count <br />1801-2711 Street, Vero Beach, FL 32960 <br />vburke@ircgov.com 772 226-1835 <br />If to the FDOT: <br />Kadian McLean, District Utilities Administrator <br />3400 W. Commercial Blvd., Fort Lauderdale, FL 33309 <br />kadian.mclean@dot.state.fl.us (954) 777-4128 <br />7. Certification <br />This document is a printout of an FDOT form maintained in an electronic format and all revisions thereto by <br />the UAO in the form of additions, deletions, or substitutions are reflected only in an Appendix entitled <br />"Changes to Form Document" and no change is made in the text of the document itself. Hand notations on <br />affected portions of this document may refer to changes reflected in the above-named Appendix but are for <br />reference purposes only and do not change the terms of the document. By signing this document, the UAO <br />hereby represents that no change has been made to the text of this document except through the terms of <br />the 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. tj�ljgree'trwiil¢ffec <br />•`ir <br />? 5 <br />UTILITY: Indian River County ` :4 <br />BY: Si nature ` ' -A <br />Susan Ad s, Ch rman •''����ttTY,��C'' + <br />(Typed Name: •• <br />(Typed Title: ) <br />Recommend Approval by the District Utility Office <br />BY: (Signature) <br />FDOT Legal review <br />the day and year first written. <br />DATE: 02/18/202C <br />DATE: <br />BY: (Signature) DATE: <br />/r, <br />District Counsel <br />t. • PI�'.9�5 <br />LEGAL SUFFICIENOY <br />Page 5 of 6 <br />i;__ Y <br />