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DocuSign Envelope ID: F310432D-F2D8-47A8-BC77-07F6F52B15BE <br />STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 710-01022 <br />UTILITY WORK BY HIGHWAY CONTRACTOR AGREEMENT occ M19 <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 parties here <br />>'c <br />UTILITY: Indian River County <br />BY: Si nature <br />Susan Adam <br />(Typed Name: <br />i 1j(IrM 1,� <br />(Typed Title: ) C'hni rman <br />Recommend Approval by the District Utility Office <br />DocuSigned by: <br />BY: (Signature)��"^ <br />�-- 45CA9F2016E949D <br />FDOT Legal review <br />BY: (Sianatu <br />- -DocuSigned by: <br />L__ 1A2o0B1o2e71Nstrict Counsel <br />STATE OF FLORIDA <br />DEPARTMENT OF TRANSPORTATION <br />BY: <br />DocuSigned by: <br />this Agreement effective the day and year first written. <br />'APPROVED AS TO FORM <br />ANb LEGAL SUFFIQF-NC) <br />NfLL1AM K.' DEBRAAL <br />COUNTY ATTORNEY <br />(Typed Name: John P. Krane, P.E.) <br />(Typed Title: Director of Transportation Development) <br />FEDERAL HIGHWAY ADMINISTRATION (if applicable) <br />BY: <br />(Typed Name: ) <br />(Typed Title: ) <br />Page 9 of 10 <br />DATE: 04/09/2024 <br />DATE:05/17/2024 1 9:07 AM EDT <br />DATE:05/17/2024 1 11:43 AM EDT <br />DATE:05/22/2024 1 4:19 PM EDT <br />DATE: <br />Attest: Ryan L. Butler, Clerk of <br />Circuit Court and Comptroller <br />By: <br />0 puty Clerk <br />