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t <br />STATE OF FLORIDA DEPARTMEW OF TSMSPORTATION 71"10-30 <br />STATE HIGHWAY LIGHTING, MAINTENANCE, AND COMPENSATION UTILITIES <br />AGREEMENT 02)03 <br />.. .. ..... Page 5 of 5 <br />9. Certification <br />This document is a printout of an FDOT form maintained in an electronic format and all revisions thereto by <br />the Maintaining Agency In the form of additions, deletions or substitutions are reflected only in an Appendix <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 Maintaining <br />Agency hereby represents that no change has been made to the text of this document except through the terms <br />of the Appendix entitled "Changes To Form Document." <br />You MUST signify by selecting or checking which of the following applies: <br />Q No changes have been made to this Forms Document and no Appendix entitled "Changes To Form <br />Document" is attached. <br />O No changes have been made to this Form Document, but changes are included on the attached Appendix <br />entitled "Changes to Forms Document." <br />IN WITNESS WHEREOF, the parties hereto have executed this Agreement effective the day and year first written. <br />MAINTAINING AGENCY <br />BY: (Signature) DATE:; <br />(Typed Name: uFMURTR P MhrRT ) <br />(Typed Title: CHAIRMAN t <br />STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION <br />BY: (Signature) <br />