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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION Form No. 710-010-21 <br />UTILITY WORK BY HIGHWAY CONTRACTOR AGREEMENT ura11114 <br />(AT FDOT EXPENSE) <br />If to the UAO: <br />Harrison Youngblood, P.E., Utilities Engineer <br />1801 - 27th Street, Bldg. A, Vero Beach, FL 32960 <br />hyoungblood@ircgov.com (727)226-4343 <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)777-4360 <br />10. 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 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 parties hereto have executed this Agreement effective the day and year first written. <br />UTILITY: Indian River County <br />BY:(Signature) DATE: <br />(Typed Name: ) <br />(Typed Title: ) <br />Recommend Approval by the District Utility Office <br />BY: (Signature) DATE: <br />175 <br />