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Form No. 710-010-64 <br />STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION UTILITIES <br />UTILITY WORK BY HIGHWAY CONTRACTOR MASTER AGREEMENT Rev. 03/00 <br />(AT UAO AND FDOT EXPENSE COMBINED) <br />only and do not change the terms of the document. By signing this document, the UAO hereby represents that <br />no change has been made to the text of this document except through the terms of the Appendix entitled <br />Changes to Form Document." <br />You MUST signify by selecting or checking which of the following applies: <br />►1 <br />0 <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, <br />Appendix entitled "Changes to Form Document." <br />IN WITNESS WHEREOF, the parties hereto have executed this AgrW- <br />UTILITY: Indian River County Department of Utility -Se 'ces <br />BY: (Signature) <br />(Typed dame: <br />but c(1oges are included on the attached <br />ayCphlMlSsj`�;�F <br />re(kffectir�tFty and year first written. <br />f , oQ • DATE: mil 7, 2020 <br />'•R��ER•COUN�•' <br />(Typed Title: Chairman Indian River County Board of County <br />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: ) <br />(Typed Title: ) - <br />FEDERAL HIGHWAY ADMINISTRATION (if applicable) <br />BY: <br />(Typed Name: ) <br />(Typed Title: ) <br />Atte*. Jeffrey R. Smith, Clerk of <br />Circuit Court and Comptroller <br />(A) ",J, <br />Deputy Clerk <br />DATE: <br />APPROVED AS -1`0 FCaPrNI <br />AND LEGAL SUPFiC15NOY <br />BYr�r.,.w �.... ,...<�_.� . ...o <br />Page 11 of 11 O LAN i=E1i'�LaI'�i_I <br />11�)Tw FtN'u' <br />