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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION UTILITY DESIGN BY FDOT CONSULTANT AGREEMENT (AT UTILITY EXPENSE) If to the UAO: Vincent Burke, P.E., Utilities Director, Indian River County 1801 -27th Street, Vero Beach, FL 32960 vburke@ircgov.com (772) 226-1835 If to the FDOT: Kadian McLean, District Utilities Administrator 3400 W. Commercial Blvd., Fort Lauderdale, FL 33309 kadian.mclean@dot.state.fl.us (954) 777-4128 7. Certification Form No. 710-010-56 UTILITIES This document is a printout of an FDOT form maintained in an electronic format and all revisions thereto by the UAO in the form of additions, deletions, or substitutions are reflected only in an Appendix entitled "Changes to Form Document" and no change is made in the text of the document itself. Hand notations on affected portions of this document may refer to changes reflected in the above-named Appendix but are for reference purposes only and do not change the terms of the document. By signing this document, the UAO hereby represents that no change has been made to the text of this document except through the terms of the appendix entitled "Changes to Form Document." You MUST signify by selecting or checking which of the following applies: ❑ No changes have been made to this Form Document and no Appendix entitled "Changes to Form Document" is attached. ® No changes have been made to this Form Document, but changes are included on the attached Appendix entitled "Changes to Form Document." IN WITNESS WHEREOF, the parties hereto have executed this Agreement effective the day and year first written. UTILITY: Indian River County BY: (Signature) DATE: (Typed Name: ) (Typed Title: Recommend Approval by the District Utility Office BY: (Signature) DATE: FDOT Legal review BY: (Signature) DATE: District Counsel Page 5 of 6 127