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710-010-22 <br />STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION UTILITIES <br />UTILIES <br />UTILITY WORK BY HIGHWAY CONTRACTOR AGREEMENT Occ-06/19 <br />(AT UTILITY EXPENSE) <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 the <br />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 <br />Appendix entitled "Changes to Form Document." <br />IN WITNESS WHEREOF, the paFtl s hel Yd have executed this AgreemerIKe th da and year first written. <br />•�; bio-• �,�'s~'; ;.:�Z, �_:i..! P�K, ����� Y Y <br />•,*- ':i'✓cC`ry`'i�i��;:_" �.��n_ �i6„1;:r"I�Ic�`.I�.i�ri' <br />UTILITY: Indian River CoOnty <br />BY: Si nature r. —.Y DATE: 11 / 15 / 2022 <br />(Typed Name: j'eluT �"0'Bryan .. <br />(Typed Title: ) Chairman <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: Steven C. Braun, P.E.) <br />(Typed Title: Director of Transportation Development) <br />FEDERAL HIGHWAY ADMINISTRATION (if applicable) <br />BY: DATE: <br />(Typed Name: ) <br />(Typed Title: ) <br />Attest: Jeffrey R. Smith, Clerk of <br />Circuit Court and Comptroller <br />Page 9 of 10 V J <br />Deputy Clerk <br />