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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION <br />UTILITY DESIGN BY FDOT CONSULTANT AGREEMENT <br />(AT UTILITY EXPENSE) <br />If to the UAO: <br />Vincent Burke, P.E., Utilities Director, Indian River Count <br />1801-271h 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 />Certification <br />Form No. 710-010-56 <br />UTILITIES <br />11/14 <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 this Ag <br />UTILITY: Indian River County <br />BY: Si nature JLI <br />Susan Adams, Chair an <br />(Typed Name: <br />(Typed Title: ) <br />Recommend Approval by the District Utility Office <br />the day and year first written. <br />'(Jii 1TY, E <br />DATE: 02/18/202, <br />BY: (Signature) DATE: <br />FDOT Legal review <br />BY: (Signature) DATE: <br />District Counsel <br />Attest: Jeffrey R. Smith, Clerk of <br />Circuit Court and Comptroller <br />d .0 L CSL 'i:F1Ci i` <br />Page 5 of 6 , <br />Deputy Clerk <br />OnWMT`4' ATTQRNr--y <br />