UTILITY WORK BY HIGHWAY CONTRACTOR AGREEMENT - FPN 256881-5-56-01STATE 6F FL4RIDr�, DEPFiRTMEiilT t)F TRANSPORTATIt}N Fatm tdo. 71Q-Of0-21
t1Ttl.ITY W{}RK BY HIGHINAY CONTRACTQR AGREEMENT �'���o�ff
�AT FDQT EXPENSE}
THiS AGREEMENT, entered into this day af , year of , by and between the STATE
QF FLL?RIDA DEPARTAtlENT OF TRANSP{}RTATION, hereinafter referred #a as the "FDQT', and City of Clearwa#er
! Public Utilities Qepartment, hereinafter referred to as the "UAt}";
WITNESSETH:
WNEREAS, the FDflT, is constructing, reconstructing, or otherwise char�ging a porfio� c�f a public rc�ad or
public�y owned rail carridor, said projec# being identified as US 19 at Flarn Road> State Road No.:55, hereinafter
referred to as the "Praject"; and
WHEREAS, the UAt? owns or desires to install certain utility facilities which are located within the lirt�its of the
Praject hereinafter referred #o as the "Facilities" {said terrrt shafl be deemed to include utility facili#ies as #he same may
be reiocated, adjusted, installed, or placed aut of service pursuant to #his Agreement}; and
WHEREAS, the Project requires the locatic�n {vertically andlor hori�an#ally}, protection, relt�catio�, atljustment
or remova! af the Faciliiies, or some combination thereof, hereinafter referred to as "Utility Work"; and
WHEREAS, the FDOT and the UAO desire to e�ter into a jc�in# agresment pursuant to Sec#ion 337.�f�3{1 }(b},
Florida Statutes far the tJtility Work t€� be accomplished by fhe FDQT's cor►tractor as part of the canstruction of the
Project; and '
WHEREAS, the FDOT, pursuant to the ter�ns and conditions �ereof, wili bear certain costs associated with the
Utility Work;
N4W, THEREFORE, in consideratian o#the premises and the mutual covenan#s contained herein, the FDOT
and the UAO hereby agree as fallows:
Design of Utili#y Work
a. UAO s�all prepare a fina! engineering design, pCans, technicai special provisions, and a cost estimate
for the Utility Wark {hereinafter referred to as the Plans Package} on or before Sent. 4, year c�fi 2{}20.
b. The Plans Package shall be in the same format as the FDQT's contract dacuments for the Project and
shall be suitable for reproduction.
c. Unless oiherwrise spec�cally directed in writing, the Plans Package shall include any and afl activities
and wc�rk effort required to perform the Utility Work, including, bu# not limited tc�, all c(earing and
grubbing, survey work, and shall include a trafFic control plan.
d. The Plans Package shall be prepared in compliance with the FD{?T's Utility Accommodatic�n Manual
anci the FDflT's Design Manual in effect at the time the Plans Package is prspared, and the FC}OT's
contract documen#s for the Project. If the FQOT's Design Manual is updated and conflicts with the
FQOT's iJtility Accammodatian Manual, the lJtility Accommodation Manual shall apply where such
confiicts exist.
e. The #echnical special provisions which are a part of the Plans Package s�all be prepared in
accordance with the FDOT's guidelines on preparatian of technical special provisions and st�all not
duplicate or change the general contracting provisions of the FQt}T's Standard Speci�catic�ns for
Road and Bridge Construction and any Supplemental Specifications, Special Provisions, or
Page 1 of 9
STATE dF F�QRIQ.�. DEPARTMENT OF 7RANSPt}RTATIQN Fotm Na. 710-010-2i
UT[LITY Wt?RK BY HIGHWAY CONTRACTOR AGREEMENT �'�'�o�o
{AT FDOT EXRENSE}
Deveiopmental Specificatians of the FDUT for the Project.
f. UAO shall pravide a capy of the proposed Plans Package #o the FD{}T, and to such other right of way
users as designated by the FDOT, for review at the following stages: Phase IV and Finai. Prior ta
submission of the proposed Plans Package f4r review at these stages, the UAO shaii send the FDOT
a work progress schectule explaining how the 11A0 will mset the FDOT's peoduction schedule, The
work prc�gress scheci�le st�all include the review stages, as well as other milestones necessary to
caenplete #he Plans Package withir► the time specified in Subparagraph a. above.
g. !n the svent that the FDOT finds any deficiencies in the Plans Package during the reviews performed
pursuant to Subparagraph f. above, the FDQT v�il! notify the UAO in writing of the deficiencies and the
UAO will correct the deficiencies and return c4rrected documents within tf�e time stated in the notice.
The FDOT's review a�d approval of the documents shail not relieve the UAQ from responsibility for
subsequently discavered errors or omissians.
h. The FD{}T shall furnish the UA{} such informatic�n from the FC}QT's files as reqc�ested by the UAQ;
however, the UAfl shall at all time be and remain solely responsible for proper prepara#ion of the
P[ans Package and far verifying all information necessary to �aroperly prepare the Plans Package,
including survey informa#ion as to the location {both ver#ical and horizontal} of #he Facilities. The
pr4viding of informa#ion by the FDOT shal! not relieve the UA4 of this obligatic�n nor transfer any af
that responsibili�y to the FDOT.
i. The Facili#ies and #he iltility Work will include all utiii#y facilities of the UAO which are lc�cated within
the limits of the Froject, except as generally summarized as foClows: �NIA}. These exceptions shall be
handled by separate arrangement.
j. The t1Afl shall fuily cooperate wi#h a!( ather right of way users in the preparation of the Plans
Package. Any conflicts that cannat be resolved through cooperatic�n shall be resolved in the manner
determined by the F[}flT.
k. Upon completian of the Utility Wo�lc, the Facilities, shall be deemed to be Ic�cated on the public road or
publicly owned rail corridor under and pursuant to the Utility Permit {N1A}.
�Nofe: If is fhe infenf of fhis Iine fr� allow eifher aftachment of r�r separafe reference fo fF�e permif�.
L The cQs# of any design wor{c performed pursuant to this paragraph 1 shal( be reimbursed by a
separate agreement.
m. As pa€t of #he final submittal of the Plans Package, the UA{} sha11 alsa submit an es#imate of the
amount of the cost of the Utility Wark tha# should be paid for by the UAO„ hereinafter refer�ed to as the
UA4 Participating Amount. The determination of that amount shall be based on the credit required for
any increase in the vaiue of the new Facility and far any saluage derived frc�m the old Facility. These
credits shall be determined as follows:
{1} Increase in value credit.
{a} Expired Service Life. If an entireiy new Facility is constructed and the o(d Facility
retired, credit far the normally-expected service life of the o(d Facility applies.
{b} Upgrading. A percentage of the tota! cost of the Relocation Work, based c�n #he
extent of the iaetterment abtained from the new Facilities will be applied.
{2} Salvage Vafue. The FDQT shall receive fair salvage value credi# for any salvage
which will become availahle to the UAfl as a result of the Utility Work.
The submittal shall show the calcuiation of the UAO Participating Amount in detaii fc�r each
af the credits required above. The FDQT sha0 review the calcuiations and advise the UAO
Page 2 a# 9
Farm No. 7tt}-010-21
S7ATE dF FIORIQA DEPARTMENT OF TRf+NSPORTATI4N UTiIiTIES
UTILITY WORK BY HIGNWAY GONTRACTOR AGREEMENT a��
{AT FDQT EXPENSE}
o# any objections. I n the event that the parties cannot come to an agreemeni as to the UAO
Participating Amount, the FQOT's dete�nination of ths amount shall prevail.
2. Peefiormance af Utility Work
a. The FDflT shali incorporate the Plans Package into its contract for canstructit�n gf the Prajec#.
b. The FDf?T shall proctare a contract for construc#ion of the Project in accordance with the FD{}T's
requirements.
c. The UA� shall perform all engineering inspectic�n, testing, and monitoring of the Utiliiy Work ta insure
that it is properly perfc�rmed in accordance with the Plans Package except for the follauving ac#iv�ies:
(N/A}
and will fumish the FQ{}T with daily diary records showing apprt�ved quantities and amounts for
weekly, monthly, and final estimates in accordance with the format required k�y the FdOT.
d. Except for the inspection, testing, monitgring and reparting tc� be perFormed �y the UAQ in
accc�rdance with Subparagraph 2. c., the FQOT will perForm all contract administration €or its
c�nstruction contract.
e. The UAO shall fu11y cooperate with the FDQT and the FDQT*s contractar in all matters relating tc� the
performance af #he Utility Work.
The FDOT's engineer has fuil authority over the Project and #he UAQ shall be responsible for
coordinating and cc�operating with the FDOT's engineer. In so doing, the UAf} shall make such
acljustments and changes in the Flans Package as the FD4T's engineer shall determine are
necessary for the prosecutian of the Pcoject.
g. The UAO shall not make any changes to the Plans Package after the date c�n which the FDOT's
con#ract documents are mailed tc� Tallahassee for adve�tisement of #he Project unless those changes
fa11 within the ca#egories of changes which are allowed by s�applemental agreernent to the FDOT's
contract pursuanf ic� Sectian 337.11, Florida Statutes. All changes, regardless of the nature of the
change or the #iming of the change, shall be subject to #he prior approval of the FDflT.
3. Cost af Utility Work
Except as athe�urise provided herein, the FDOT shall be respc�nsible for al! costs of the Utility Work
and all costs associated with any adjustments ar changes #o the Utility Work determined by the
FDOT's engineer t4 be necessary, including, but not limited ta the cost of changing ihe Plans
Package and the increase in #he cost of perfom�ing the Utiiity Work, uniess the adjustments o�
changes are necessitated by an error or omission of the UAO. The FQOT shall not be responsible
fc�r the cost of delays caused by such adjustments or changes to the e�ent they are attributabfe to
ihe UAD pursuant to Subparagraph 4.a.
b. At such time as the FDOT prepares its official estimate, the FQOT shali notify the UA{} of the UA{}
Participating Amc�unt, deiermined in accordance with Subparagraph 1.m. hereof.
c. At least thirtv {3{}} days pric�r to the date on which the FDQT advertises the Project for bids, the UAQ
will pay to the FDQT the UAQ Participating Amount.
d. If the UAO's percentage cantribution to the portian of the bid of the contractc�r selected by the FQOT
which is for pe�#ormance of the Utility Work {calculated by dividing the UAO's Pacticipating Amount
by #he amount of the FDOT's o�cial estimate} exceeds the arnc�unt of the deposit made pursuant to
Subparagraph c. above, then the UAQ shafl, �vithin fourteen {14} calendar days from notification from
the FC30T, or prior to posting of the accepted bid, whiehever is earlier, pay a� additional amount to
the FDOT ta bring the total amount paid to the total percentage contributic�n of the UAQ. If said
Page 3 of 4
STRTE QF FIdRIII;; QEPAftTMENT �F TRANSPORTAT(f}N Form No. 710-01Q-21
UTii.IT1ES
UTIE.ITY WORK BY HtGHWAY CflNTRACTQR AGREEMENT ���
{AT FQt}T EXPENSE}
po�tion of the bid is less than the amount on deposit, the excess deposit shall be returned to the UAQ
in accordance with Section 215.�22, Florida Statutes.
e. The FDflT may use the funds paid by the UAQ for payment o€ the cost of the Utility Work.
Payment of the funtis pursuant to this paragraph will be made {choose one):
� directly to the FDOT far deposit into the State Transpo�tation Trust Fund.
❑ as pravided in #he aftached Three Party Escrow Agrsement between the UAO, the FD07,
and the State of Florida, C}epa�tment af Financial Services, Qivisian of Treasury. E}epc�sits of
less than $1{}Q,Q00.00 mus# be pre-approved by the C}epa�tment c�f Financial Services and
FDOT Comp#roller's t}�ce priar to execution of this agreement.
Upon final payrt�ent to the contractor, the FDOT intends to have its final and complete biiling of a(I
cos#s incurred in connec#ion with the Utility Work within three hundred si�y {36�} days. All cost
records and aecounts shall be subject to audit by a representative of the UAt} within three {3} years
after final c(ose out of the Project.
4. Claims Against UAQ
a. The UAO shall be responsible for all costs incurred as a result of any delay ta the FD{}T or its
cantractors caused by errors or c�missions in the Plans Package {including inaccura#e lcacatic�n t�f the
Facilities} or by failure of the UAO to properly perfom� its obligations under this Agreement in a timely
manner.
b. In the event the FD4T°s conteactar provides a notice af inten# io make a claim against the FDOT
relating to the Utiiity Work, the FDOi will natify the UAO of the notice of inten# and the UAO will
thereafter keep and maintain daily field reports and ail other records relating tc� the intended claim.
c. In the event the FQQT's contractc�r makes any claim against the FQQT relating tc� the Utili#y 1lVork, the
FE}OT wil! notify the UAO af the claim and the UAQ wil( cooperate with the FDOT in analyzing and
resolving the claim within a reasonable time. Any resolution of any portic�n of the claim directly
beiween the UA{} and the FQOT's contractor shall be in writing, shall be subject to written FDOT
concurrence and shall specify the e�ent to which i# resolves the ciaim against the FDOT.
5. Out of Service Facilities
No Faciiities shall be placed 4ut of service unless specifically identified as such in the Plans Package. The
following terms and canditions shall apply to FaciGties placed Out-af-Service:
a. The UAO acknowfedges its present and continuing ownership of and responsii�ility for t�ut of service
Facilities.
fa. The FQQT agrees to alfaw the UAO to leave the Facilities within the righ# c�f way subject to the
cantinuing satisfactory performance of the conditians of this Agreement by UAO. In ths event a# a
breach of this Agreement by UAO, the Facilities shall be removed upon demand from the FDOT in
accordance wi#h the pravisions of Subparagraph e. below.
c. The UAO shall take such s#eps tt� secure the Facilities and otherwise make the Faciiities safe in
accorclance with any and all applicable local„ state or federal iaws and eegulatit�ns and in accordance
with #he legal duty c�f the UAO to use due care in its dealings with others. The UA{} shall be solely
responsible for gathering all infarmation necessar}t to meet these abligations.
d. The UAO shafl keep and presenre all records relating to the Facilities, includsng, but not limited to,
records of the location, nature of, and steps taken to safely secure the Facilities and shall promptly
Page 4 0# S
Fatm NcF. 710-070-21
STATE 4F F�ORIGA QEPARTMENT OF TRANSPf}RTATIQN UTtLITIES
UTI�iTY WORK BY HIGHWAY CONTRAGTOR AGREEMENT ���
{AT FQ�T EXPENSE}
respond to infarmation requests of the FDOT c�r o#her permittees using or seeking use of the righ#
af way.
e. The UAti shali remove the Facilities at the request of the FDQT in the event that the FDflT
determines #hat removai is necessary fc�r FDQT use of the right c�f way or in the event that tt�e FDQT
deterrr�ines that use of the right of way is needed for other active utiiities that cannot be otherwise
accommodated in the right of way. In the event that the out of service Facilities wc�uld have qualified
for reimbursemen# only under Section 337.403{1 }{a}, Florida Statutes, removai shall be at the soie
cast and expense of the UA4 and witt�out any right a# the UAO to object or make any claim of any
nature whatsoever with regard thereto. In #he event that the out of service Facili#ies w4uld have
qualified for reimt�ursement for othe� reasons, removal af the out of service Facilities shall be
reimbursed by the FDOT as though it had nc�t been placed oc�t of service. Removal shall be
campleted within the time specified in the FD{}T's nt�tice to remove. In the event that the t11�0 fails
to pe�€orm the removal properiy within the specified time, the FDOT may proceed to perforrr� the
remova( at #he UAO's expense pursuant to the provisions t�f Sectic�ns 337.403 and 337.40�, Flc�rida
Statutes.
Excepi as otherwise p�ovided in Subparagraph e. above, fhe UAfl agreas that the Facilities shal!
forever remain the legal and financiat responsibility of #he UAO. The UA4 shall reimburse #he FQQT
for any and all costs of any na#ure whatsoever resulting from the presence af the Facilities within the
right of way. Said cc�sts shali include, but shall not be limited #o„ charges or expenses which may
result from the future need to remc�ve #he Facilities or from the presence of any hazardc�us subs#ance
or mateeial in or discharging frt�m the Facilities. Nothing in this paragraph shal! be interpretec! to
require the UAQ to inderranify the FDOT fQr the FDOT's awn negligence; however, it is the intent #hat
all other costs and expenses of any nature be the responsibility of the UAO.
6. Default
a. In the event tha# the UAO breaches any provision of this Agreement, then in addi�ian ta any other
remedies which are otherwise pravided for in this Agreament, the FDQT may exercise one or more of
the following aptic�ns, provided that at no time shall the FDOT be entitled to receive double recovery
of damages:
{1 } Terminate this Agreement if the breach is material and has not been cured within sixty {80}
days from written natice thereof from FDQT.
{2} Pursue a ciairr� for damages suffered by the FDQT.
{3} If the U#ility Work is reimbursable under this Agreement, withhold reimbursement payments
until the breach is cureti. The right to withhold shall be limited to actua! claim payments
made by FC}OT ta third parties.
{4} If the Utiiity Work is reimbursable under this Agreament, offset any damages sufFered by the
FC}OT or the public agains# payments due under this Agreement #or the same Project. The
right to offset shall be lirr�ited to actual claim payments made by FC}QT to third parties.
{5} Suspend #he issuance of further permits ta the UAQ for the placement c�f Facilities on FQQT
property if the breach is rnaterial and has not been cured within sixty {60} days from written
notice thereof from FDOT until such time as the breach is cured.
{6} Pursue any other remedies legally available.
Page 5 of 9
STATE QF �L4RtGA DEPARTMENT QF TRANSP{}RTATIC}N F� ��� ������ 2t
UTIlIT1ES
UTILITY W4RK BY HIGHWAY C4NTRACTOR AGREEMENT 4��
{AT FQOT EXPENSE}
�7} Perform any work with its awn farces or through cantractors and seek re�aayment fc�r the cost
thereaf under Section 337.403{3}, Florida Statutes.
b. In the event that the FDt}T breaches any pravisit�n c�f this Agreement, then in addition ia any other
remedies which are otherwise provided for in the Agreement, #he llAO may exercise ane or more of
the follawing options:
{1 } Terminate this Agreeme�t if the breach is rnaterial and has not been cured within si�cty {60}
days from wri#ten notice thereaf from the UAO.
{2} If the breach is a failure to pay an invoice for iltility Work which is reirr�bursable under this
Agreement, pursue any statutory remedies that the UAO may have far failure to pay
invoices.
(3} Pursue any other remedies legally available.
c. Termination af this Agreement shall not relieve either party from any obligatic�ns it has pursuan# to
other agreements between the parties nor #rom any statutory obiigatians that either party may have
with regard to the subject matter hereaf.
7. Force Majeure
Neither the UAd nor the FD{}7 shall be liable to the other for any failure to perform under this Agreement to
the e�ent such performance is prevented by an act of God, war, ric�ts, natural catastrsaphe, or other event
beyond #he control of the non-performing parky and which could not have been avoided or overcome by the
exercise of due diligence; provided that the party claiming the excuse from performance has {a} promptly
noti�ed the other party of the c�ccurrence and its estimated duration, {b} protnpt{y remedied or mitigated the
effect of the occurrence to the e�ent possible, and {c} resumed per#ormance as soo� as possible.
8. lndemni�cation
FQR GQVERNMENT-OWNED UTI�IT(ES,
To the a�ent provided by iaw, the UA4 shali indemnify, defend, and hold harmless the FDOT and all o# its
oificers, agents, and emplayees from any claim, foss, damage, cost, charge, or expense arising crut of any
acts, action, error, neglect, or omissian by the llAO, its agents, employees, or cc�ntractors during the
performance of the Agreement, whether direct or indirect, and whether to any persc�n or property to which
FDflT or said parties may be subject, except that neither the UAQ, its agents, employess, or contractors will
be liable under this section for damages arising out of the injury ar damage ta persons or prope€ty directly
caused by or resul#ing from the negligence of the FQOT or any of its officers, agents, ffr employees during the
performance of this Agreement.
When the FDOT receives a notice of claim for damages that may have been caused by the UAQ in the
performance of senrices required under this Agreement, #he FDOT will immediately forvirard the claim to the
UAfl. The UAO and the FDOT will evaluate the claim and repo�t their findings to each other within four#een
{14} working days and will jointly discuss aptions in defending the claim. After reviewing the claim, the FC}t?T
will determine whether to require the participation of the UAf} in the defense of #he claim or to require the
UAO to defend the FDOT in such claim as described in this sectian. The FDflT's failure to natify the UAO of
a claim shall not release the UA4 fram any of the requirements of this section. The FQOT and #he UAQ will
pay their c�wn costs far the evaluatian, settlement negotiations, and trial, if any. However, if oniy one party
participates in the defense af the elaim at tria(, that party is respansible far all costs.
Page & o# 9
Farm No. ; iQ�10-21
STATE OF Flt}f2IDr� QEP.�.RTMENT 4F TRANSFC}RTATION �-�����Eg
UTI�ITY W{?RK BY NIGHWAY CflNTRACTQR AGREEMENT ���
{AT FQC}T EXPENSE}
FQR NON-G{)VERNMENT-OWNED UTILiT1ES,
The UAt} st�a11 indemnify, defend, and hold harmless the FDOT and ali c�f its officers, agents, and emplc�yees
frc�m any claim, foss, damage, cost, charge, ar expense arising out of any acts, actic�n, error, neglect, or
omissian by the UAO, its agents, employees, or cc�ntractors during the perFc�rmance of #he Agreement,
whether direct or indirect, and whether to any person or property #c� which FQOT or said parties may be
subject, except that neither #he UAQ, its agents, emplc�yees, or contrac#ors will be IiaE��e under this section for
damages arising out of the injury or damage to persons or property directly caused by or resufting #�om #he
negligence af the FDOT or any of its officers, agents, or employees during the performance €�f this
Agreement.
The UAO's c�bligation to indemnify, defend, and pay for #he defense or at the FDQT's Qption, ta participa#e
and associate with the Fi}OT in the defiense and trial o€ any �iamage claim or suit and any related settlement
negotiations, shai! arise within fourteen {14} days of receip# by the UAQ of the FQOT's notice of claim for
inc�emnification ta the UAQ. The notice of claim for indemnification sha�( be served by certified rr�ail. The
UAQ's abliga#ion to defend and indemnify within fourteen {14} days of such no#ice shall not be excused
because af #he UA4's inability to evaluate liability or because #he lIAO evaluates liability and deterrnines the
UA{} is not liable or determines the FC}OT is solely negligent. Uniy a final adjudication c�r judgment fnding
the FDOT solely negligent shall excuse perfarmance of this provision by the UAO. The UAO shall pay ali
costs and fees re(ated to this obligation and its enforcement by the FQflT. The FQOT's delay in notifying #he
UAO af a claim shall not eelease UAO of the above duty to defend.
9. Miscellaneous
a. Time is of essence in the performance of all obiigations under this Agreeme�t.
The Facilities shall at ali times remain the property of and be properly prc�#ected and maintained by
the UAO in accordance with the current Utility Accommodation Manual in ef%ct at the time the Plans
Package is prepared and the current utiiity permit for the Facilities; provided, t�c�wever, that the UAO
shall not be ok�ligated to protect or maintain any of the Faci(ities ta #he e�ent the FDQT's con#ractor
has that obligatian as part of the Utility Work pursuant to the FDOT's specifications.
c. The FDOT may unilaterally cancel this Agreement for refusai by the UAQ ta allow public access tc� all
dc�cuments, papers, let#ers, or other material subjec# ta #he provisions of Chapter� 119, Flc�rida
Sta#utes, and made or received by the UAO in conjunction with this Agreement.
d. This Agreement constitutes the complete and final expression of #he parties with respect to the
subjec# matter here�f and supersedes a(1 prior agreements, unders#andings, or negc�tiatit�ns with
respec# thereto, except that the parties unders#and and agree that the FQt}T has manuals and
written poiicies and procedures which may be applicable at the time of the Project and #he reiocation
af the Facilities.
e. This Agreement shall be governed by the laws of #he State of Florida. Any prt�vision hereof found to
be ur�lawful or unenforceable shall be severabie and shall not affect the validity of the remaining
portions hereof.
f. A11 notices required pursuant to the terms hereof may be sent by first class United States Mail,
facsimile transmission, hand delivery, or express mail and shall be deemed #o have been received by
tha end of frve business days from the proper sending thereof un(ess proo# of priar acival receipt is
provided. The UAO shall have a continuing obligation tc� notify each District flf the FD�T of the
appropriate persons for natices to be sent pursuant to this Agreement. Unless otherwise notified in
writing„ notices shall be sent to the following addresses:
Page 7 ot 9
Fotm Plo. ;10-010.21
STATE 4F Fl.OR16r� QEPARTMENT 6F TRr1NSFORTATI{}t�t UTIi�tTkES
UT(�ITY WQRK BY HIGNWAY CONTRACTOR AGREEMENT 4��
{AT FQQT EXPENSE}
If to the UAQ:
Duy Nguyen E 1 Senior Enqineering Specialist
100 S Myrtle Ave
Clearwater, FL 33756
(f to the FDQT:
C}aniel Fiuntee, C}istric# Utilities Administrator
11201 N McKinley Q� MS 7-82Q
Tampa F� 33612
10. Gertification
This document is a printout of an FD4T form maintained in an electronic format and a�l revisians thereto by
the UAQ in the form o# addi#ions, deletions, ar substitutions are reflected only in an Appendix entitled
Changes To Fo�m Docume�t and no change is made in the text of the document itself. Hand nt�tations on
afFected portions of #his document may refer to changes retlected in the above-narned Appendix bufi are for
reference pueposes only and do nat change #he terms c�f the documen#. By signing this document, the UAO
hereby represents that nc� change has been made to the text of this document except thrc�ugh the terms c�f the
appendix entitled Changes To Form Qocument.,,
Yau Ml1ST signify by selecting or checking which of the following appiies:
❑ No changes have been made to this Form Document and no Appendix entitied "Changes to Form
Dacument" is attached.
� No changes have been made to this Form Document, but changes are included Qn the attached
Appendix entitled "Changes to Form Document."
IN WITNESS WHEREOF, the parkies hereto have executed this Agreement effective the day and year first written.
UTILITY: City o# Clearv+rater 1 Public U#ilities Qepartment
BY.(Siqnature} C}AiE:
{Typed Marr�e: tsee a�t�endix}}
{Typed Title• }
Recommend Appraval by the i}istrict Utility f3ffice
BY: �Siqnature) DATE:
Page 8 af 9
Form Na.714-fl1�-21
STATE OF Fl�ORIQA CiEPRRTMENT QF TRANSPORTATIOM tJTlLtTkES
UTt�ITY WORK BY HIGNWAY CONTRACTOR AGREEMENT ���
{AT FDflT EXPENSE}
FQQT Legal review
BY; {Siqnature} QATE:
Dis#rict Gounsel
STATE QF FLQRiDA
DEPARTMENT OF TRANSPORTATIQN
BY: {Siqnature} DATE:
{Typed Name: Richard IVloss. PE}
{Typed Title: Directoc of Transportation Development}
FEDERA� HtGHWAY AQMINISTRATION {if applicable}
BY� DATE:
{Typed Name: }
{Typed Ti#le: _}
Page @ of 4
APPENDI�
State of Florida Department of Transgortation
UTILITY �'�ORK BY HIGFIWAY CQNTRACTQR AGREEMENT
��IANGES TO FQRM D{}CU1��ENT
F'PID: �09155-1-56-01
1. Page 9 of 9, fo�lowing :`IN WITNESS ��'HEREOF...year first ��ithin.,'
Add the fo11o�£in� signature blocks fo��o���ing the "Uti�ity...(T�ped Title}" bian�:
Countersi�ned:
CITY OF CLEARWATER, FI,{}RIDA
�� � �� '� � - - � ,
� By:
� nk Hibbard �'4 illiam B. I-�c�rr�e II
l��ayor
Approved as t form:
� ��� �A
Laura Mahony
�ssistant Cit�°
City I��anager
Attest:
� � �
�� � � �, �
���--�� ��'� �
Rasemarie Call
City= C1erk