04/20/2016710.010-05
Rule 14�6 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION UTILITIES
UTILITY WORK SCHEDULE 12109
Page 1 of 3
Financial Project ID: 413721-2-52-01 Federal Project ID: N/A
County: Monroe State Road No.: 5
District Document No: N/A
Utility Agency/Owner (UAO): Board of County Commissioners of Monroe County
A Summary of Utility Work And Execution
Estimated Time
(calendar days)
Total Time Prior To FDOT Project Construction 0
Total Time During FDOT Project Construction 0
This document has been developed as the method for a Utility Agency/Owner (UAO) to transmit to the Florida Department of Transportation
(FDOT), the FDOTs Contractor, and other right-of-way users, the location, relocation, adjustment, installation, and/or protection of their
facilities, on this FDOT project. The following data is based on FDOT preliminary construction plans dated 9/30/2015 . Any deviation by the
FDOT or its contractor from the plans, as provided, may render this work schedule null and void. Upon notification by FDOT of such
change, this utility may require additional days for assessment and negotiation of a new work schedule. This UAO is not responsible for
events beyond the control of the UAO that could not reasonably be anticipated by the UAO and which could not be avoided by the UAO with
the exercise of due diligence at the time of the occurrence. The UAO agrees to notify the Department in writing prior to starting, stopping,
resuming, or completing work.
UAO Project Representative: Telephone Number:
UAO Field Representative: Telephone Number:
This document is a printout of an FDOT form maintained in an electronic format and all revisions thereto by the UAO in the form of
additions, deletions or substitutions are reflected only in an Appendix entitled "Changes to Form Document" and no change is made in the
text of the document itself. Hand notations on affected portions of this document may refer to changes reflected in the above -named
Appendix but are for reference purposes only and do not change the terms of the document. By signing this document, the UAO hereby
represents that no change has been made to the text of this document except through the terms of the appendix entitled "Changes to Form
Document".
You MUST signify by selecting or checking which of the following applies:
® No changes to forms document.
❑ Appendix "Changes to Forms Document" is attached. _ Number of Attachment Pages.
Author'zed Utility ge ""Engineer of Record (EOR►: Acce by Distri�til' '
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(""When requested by the District, the FOR will attest to compatibility of plans, specifications and Utility Work Schedule)
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3
AMY REAVILIN, CPA
CLERK OF CIRCUIT COURT &COMPTROLLER
xaNxoE couxrr, FLORIDA
DATE: August 1, 2016
TO: Judith Clarke
Director of Engineering
ATTN. Breanne Erickson, Senior Engineering Technician
FROM Cheryl Robertson Executive Aide to the Clerk of Court & Comptroller CAL
At the April 20, 2016 Board of County Commissioner's meeting the Board granted approval and
authorized execution of Item C5 Approval to allow Director of Engineering Services, on behalf of the
County, as owner, to sign a Utility Work Schedule for the removal of the existing out -of -service 18"
water main connected to the Old Seven Mile Bridge.
CC: County Attorney
Finance
File
500 Whitehead Street Suite 101, PO Box 1980, Key West FL 33040 Phone: 305-295-3130 Fax: 305-295-3663
3117 Overseas Highway, Marathon, FL 33050 Phone: 305-289-6027 Fax: 305-289-6025
88820 Overseas Highway, Plantation Key, FL 33070 Phone: 852-7145 Fax: 305-852-7146