14-E7. B2 UWS.pdf

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Rule 14-46.001 F.A.C

FLORIDA DEPARTMENT OF TRANSPORTATION

UTILITY WORK SCHEDULE

December 14, 2016

Pursuant to Section 337.403 F.S., the UAO and FDOT agree to the UAO’s need for relocation or adjustment to its utilities and FDOT’s need for a schedule for the UAO to effect the relocation or adjustment. This utility work schedule is based on FDOT plans dated in the project information box below. Any deviation by FDOT or its contractor from these plans, may void this utility work schedule. Upon notification by FDOT of a change to these plans, the UAO may negotiate a new utility work schedule. The UAO agrees to notify FDOT and the contractor in writing prior to starting, stopping, resuming, and completing work in accordance with this utility work schedule. The UAO shall obtain a utility permit and comply with requirements of the 2017 Utility Accommodation Manual (UAM) for all work done under this utility work schedule. The UAO is not responsible for events beyond the control of the UAO that could not be reasonably anticipated by the UAO and which could not be avoided by the UAO with exercise of due diligence at the time of the occurrence.

FDOT PROJECT INFORMATION

Financial Project ID: 254677-2-52-93 TWO 43 Federal Project ID:

State Road Number: 55 County: PASCO FDOT Plans Dated: 06/12/2023 District Document No.:

UTILITY AGENCY/OWNER (UAO)

Utility Company: Pasco County Utilities UAO Project Rep: Sarah Rodriguez, P.E. Phone: 813-235-6193 E-mail: srodriguez@pascocountyfl.net UAO Field Rep: Brad Surrency Phone: 727-992-7873 E-mail: bsurrency@pascocountyfl.net

UTILITY SIGNATURE

I have reviewed the FDOT plans referenced above and submit this utility work schedule in compliance with UAM Section 5 and agree to be bound by the terms of this utility work schedule.

UAO Rep. Date 8 / 14 / 2023 Name Sarah Rodriguez, P.E.

Title Engineering Manager

ENGINEER OF RECORD SIGNATURE

I attest this utility work schedule is compatible with the FDOT plans referenced above.

EOR. Date / / Name Daniel A. Carnley, P.E.

Title Sr. Project Manager

APPROVAL BY DISTRICT UTILITIES

This utility work schedule is complete and acceptable to FDOT.

FDOT Rep. Date / / Name N/A Title N/A

SECTION A: SUMMARY OF UTILITY WORK

The below days are the total numbers of days shown for all activities in Section C of this utility work schedule. The breakdown of how these days are to be incorporated into the FDOT project and the dependence of these days upon the completion of other activities by the UAO or others is shown in Section C.

Days prior to FDOT project construction: 5 Days during FDOT project construction: 1 ed the FDOTOTOTOOOOO plans referencececcccccceceeed d dddddd abov ep.

me Sarah Rodrigggggggggggggggggggggggggguuuueuu z, P.EEEEEEEEEEEEEEEEEEEEEEEEEEEE.

Financial Project ID: 254677-2-52-93 TWO 43

FDOT Plans Dated: 06/12/2023

SECTION B: UAO SPECIAL CONDITIONS/CONSTRAINTS

1. The County requests that the Contractor provide notification at least 48 hours prior to any excavation within 3 feet of any existing utility piping, valves, hydrants, etc.

Financial Project ID: 254677-2-52-93 TWO 43

FDOT Plans Dated: 06/12/2023

SECTION C: UAO’s WORK ACTIVITIES

Act.

No.

Utility Facility (type, size, material, status)

From Station/ Offset

To Station/ Offset

Utility Work Activity Description

Dependent Activity TCP Phase

Consecutive Calendar Days

Prior to During Const. Const.

1 Existing 4” PVC FM 110+18, 89’ LT

110+38, 89’ LT

Ex. 4” PVC FM piping to be replaced and offset toward roadway to provide horizontal clearance (min. 5’) for proposed mast arm foundation installation

N/A N/A 5 0

2 Existing 30” D.I. WM 110+35, 91’ RT -

Monitor ex. WM piping during excavation for mast arm foundation installation

Coordinate with installation of foundation casing/excavation activities 2 (Stage 1) 0 1

2023-08-17T18:53:26-0400

State of Florida, Professional Engineer, License No. 75529. This item has been digitally signed and sealed by Daniel Carnley, PE on the date indicated here. Printed copies of this document are not considered signed and sealed and the signature must be verified on any electronic copies.

Daniel Carnley

RWCO COUNTY ENGINEERING 8ERVCES

UTILFTY WORK SCHEDULE

Project Collier Parkway at Llvlngaton Road Intenectlon Imprownmt*, Puco County, FL Work Order Number: EDO 020-038 Project ID:

Road Name / No. : Colltor Parkimy/County Line Road and Llvlngrton Road

A. Duka Eneiay-DtotribuUon Summi of Utility Work and Execution

RigeltrfS

Total Time Prior to Project ConstrucUon Total Time During Project Constnictlon

Estimated Time (calendar days)

OOP

Thb document has been developed as the method far a UUIIty Ageniy/Owner (UAO) to transmit to Pasco County, the Counly's Contiactor, and othwrlghKf-way usem, the location, relocaUon, adjustmmt. Installation, and/or protedlon of their tadlltles. 'on thte Improvement piaii project. The foltowlng data te based on preliminary oonatructlpn plans dated June 3. 2021 _. Any deviation by Pa«co County or Its contractor ftom the planB, ae provided, may render thla woik schedule null and void. Upon notfflcatton by Pa«co County of such change, this utility mqf requireaddlUonal days for assessment and negotlBtlon of a new work schedule, "nils UAO Is not responsible for evento beyond the control of the UAO that oould not reasonably be antlcipatBd by ttie UAO and which couU not be avddad by the UAO with the exercise of due diligence at the tlmB of the occunBnca. The UAO agrees to notify Pasco County in wrtUng prior to starting, stopping, or completing work.

UAO Project Representathre:

UAO Field Representative:

BILL RULAND

SHAWM VOLHBM

Telephone Number:

Telephone Numban

727-82M641 407-205-5218

This document Is a printout of a fonn maintained In an electronic format and dl nBvlslons thereto by the UAO in the fomi of addittons. delettons or subsUtutlons are reflected only in an Appendix enUUed "Changes to Fonn DocumBnl" and no change is made In tha text of the document Itself. Hand notaUom on affected porttona of this document may mfer to changes reflected In the above-named Appendix but are for reference purposes only and do not change ths temiB of the document. By signing this document, the UAO heraby repreeente that no chanae haa been made to the text of this document except through the terms of tha appendix entitled "Changea to Fomi boajment".

You MUST signify by selecUng or cheddng which of the following applies:

Q No changes to forms document.

D AppBndix "Changes to Forms Documsnr Is attached, Authorfaed UUIIty Ag t:

(Slgnalun)

Bll Ruland (PrinladNama)

En namf Tedmol It III

(TW)

7/15/21 (Data)

Number of Attachment Pages.

'Record (EOR):

J Siewert P. E.

(Printed Name)

Ineer of Record

I")

1 2*Z Die) by

(81gnateiml It unty:

CHiaisiypH St. view p. £, (PifntNlNinn) Aw- »'*».

Bmtort Manwr frwrr

(Date)

RWCO COUNTY ENGINSRING SERVITCS

Project: Collier Parimny at LMngdnn Road Intenectlon Improvemenls, Parco County, FL Woik Onhr Number X109S9 p^r2or3

Road Name / Na: Collier ParlurayHSounty Line Road and LMngston Road

B. Spedal CondiUons / Coiwtialnts

1) Emergency number for nights, weekends and Duke Energy Florida holidays is (800) 228-8485.

) A copy of the qiproved contractor's CPM (critical path method) is requested within 5 days of the contract being awarded.

) Date Ener^ requeste fliat fhe contractor provide the foUowing prior to installation of Duke Energy facilities during coDshucdon: right of way OW) cleared and cubbed, find grade staked, station numbers staked, and ROW staked. Duke Eaagy understands diatPasco County wffl only e able to provide ROW staking for any work that is identified as prior to construction.

) Tins UAO's poles, scheduled to be removed, will be removed witfain 30 days fiom when they are cleared by all joint USCTS.

) Anytenqxnaiy bracing or holding of this UAO's poles, existing or proposed that have not been identified in this work schedule, required fin-asco County constmction, will require fhirty (30) worldBg days advanced notice by Pasco County to this UAO's representative.

) Duke Enragy requests Bucket Truck access in order to maintain all of toe UAO's eiusdng and proposed pole, pull box, and switchgear locadons ughout the duration of the project construction for maintenance and outage restoration.

Duke Energy Distribution camrot remove old &cilities until new fiicilities are energized and existing customers services have been relocated.

8) Duke Energy's resources can also be affected by weather not directty contacting die Florida region as the company supports other utility 'es in suiiounding areas and states.

) A^D'AeEner©r facaUtira are energized at 24.94KV (25KV) "Excq)t as olherwise may be piovided in Part C "Description ofUfiUty Woik1' of s Utility Work Schedule, Duke Energy overhead electric fiicilities to remain energized and in place. Table A "Mmimmn Clearance Distances edin Subpart CCofOSHA Rule 29 CER Part 1926 (as they pertain to crane/demck operations), and/or those minimiim distances spectGed

29 CFR 1910.33(c)(3) for woric in proximity to pcwer lines not covered by this Subpart CC", must be mamtained.

RASCO COUmV ENGINEERING SEFMCES

UTILFTYWORK SCHEDULE

Project Collier Paikway at Uvingrton Road InterBecUon Impnwamante, Paaco County, FL Walk Older NunAen X10959

Road Name / No.: Collier PariniayfCounty Line Road and Uvingston Road

P^|B3of3 c.

UTIUTY FACIUnES BY STATUS TYPE/SIZEffl«ATERIAUOFFSET TO

BASEUNE FROM STA TO STA

N/A

Existing pole and qipurtenances

STA. 11+92, 36'LT.

Proposed OE 7.2kV conductor flom STA. ll+92. 36'LT. to

STA. 12+86. 36' RT.

Proposed pole and qipurtaaances

STA. 12+86. 36'RT.

Proposed BE 7.2kV conductor fiom STA. 12+86, 36' RT. to

STA. 12+65, 36' RT.

Proposed pullbox

Proposed OE 7.2kV conductor fiwn STA. 12+86. 36' RT. to

STA. 15+33, 32'RT.

Proposed pole and appurtenances

STA. 15+33, 32' RT

Disposition of Faclllttea (Ust All ExhUng & Propcued) on Project

DESCWFTION

OF

UTIUTTWORK

Notice to proceed

Engineering Design

Pennit Application

Material Procurement

To be modified in place and in service

To be installed

DEPENDENT

ACTIWTIES

Notice to

Placement of proposed poles

ROW staked, cleared, grabbed, etc.

grubbed, etc.

grubbed, etc.

M.O.T.

PHASE

NUMBER

CONSECUIWE

CALENDAR

DAYS

Proposed span guy from STA. I5+33. 32'RT. to

STA. 15+24 30' LT.

Proposed pole and ippurtcuMccs

STA. 15+24, 30' LT.

Proposed OE 7.2kV conductor fi-om STA. 15+33. 32'RT. to

STA. 16+83, 16' RT.

Existing pole and appurtenances

STA. 16+83. 16'RT.

Existing OE 7.2kV conductor fiom STA. ll+92, 36'LT. to

STA. 12+86, 22' RT.

Existing pole and sqipurtenances

STA. 12+86, 22' RT.

Existing BE 7.2KV ccmductor fi-om STA. 12+86, 22'RT. to

Existing OE 7.2kV conductor fiom STA. 12+86, 22'RT. tu

STA. 15+30, 17' RT.

Existing stub pole

STA. 13+69, 20' RT.

Existing pole and q)purtenances

STA. 15+30, 17' RT.

Existing span guy fixmi STA. 15+30, 17'RT. to

STA. 15+26, 15' LT.

Existing pole and appurtenances

STA. 15+26, 15' LT.

PASCO COUNTY B<GI ERING SERVICES

UTIUTY WORK SCHEDULE

4of3

To be modified in place and in service

To be removed

To be placed out of service

To be removed once joint use vacates pole gmbbed, etc.

&conductor

&c<niductor

& conductor

&con<Iuctor

Existing OE 7.2kV coaductxir fiom STA. 15+30, 17' RT. to

STA. 1&1-83, 16' RT.

MSCO OOUNTV ENGINSRING SERVICES

UTILTTY WORK SCHEDULE

&coiiductor

5of3

RMCO COUWY ENOINEEmNB 8ERVICB

UTILmr WORK SCHEDULE

Prelect Collier Paikway at Llvlngrton Road In-mecUon Improwmenh, Pano County, FL Work Ontor Number: X109W

Road Name / No. : Colllm Partnray/County Line Road and Uvlngaton Road

A. FTR Summaiy of Utility Work And Execution

R^»1nf3

Total Tme Prior to Project Construction Total Time During Project Consbuctton

101_

This document has been developed aa the method for a UUIity ̂enty/pwnsr (UAO) to transmit to Pasco County, the County's Contractor, and othenfght-of-way usefB, the tocation, relocation, adjuBtnient Installatton, and/or protection of their facllltles. 'on this 1mpn>vement'~pian projad. Th8 Mlowing data l8 based on preliminary constuctlon plans datad Juna 3. 2021 _'. Any deviation by Pasco County or te contractor from the plans, as provided, may render this work schedule null and wld. Upor^nomcatton by Pasco County of such change, thte utility m^mqulreaddlttonal days for assessment and negoUationofanewvmrk schedute, TOB UAO te not responsible for everite beyond the control of the UAO that oould not reasonably be antidpated by the UAO and which could not be avoided by the UAO with'the exerdse of due diligence at the time of the occunance. The UAO agrees to notify Paaco County In writing prior to atartlng, i or completing work. - ' ' ~ . ----^. - rr... »,...... a, UAO Project RepresantatlvB; Kralvuth Choeykrajang

UAO FleU RBpmaentaUve: Paul linebeny Telephone Number

Telephone Number:

941-604-4881

81M3MB87.

Thh document Is a printout of a form maintained In an electronic format and all ravlalons thereto by the UAO in the form of additions. deleUons or subaUtutlons are reltected only in an Appendbi entitled 'Changes to Fonn DocumBnr and no change to 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-formfeiB nce purposea only and do nol change the terms of the document. By signing thte document, the UAO hereby repreBtinte that no change has beeii made to the text of thto document except through the taims of the appendix entitled "Changes to Fonn bocumenr

You MUST dgnVy by selecting or checking which of the Ibltowing applies;

Appendix "Changes to Fomis Documert" Is attached._Number of Attachment Pages.

Authortead Utility Anent:

/MWH^

(SlQmtun

Kraivuth Cho kra an (PrlnhdNinr)

En r Netwoik Sr (T«)

07/16B021 (Drt«>

?cord (EOR):

^^-fc=-a

Stowert P.6.

(PrtntKl Name)

E near of Record fTltto) ce Pa nnatum) isp»p«ei2-\<sie>a"i?.» nniilrWnUiinll. E.

(PilnhdNmr)

ABT . 6M^. 5aB**i u£-T>l »d<n* fT*)

-G. -Z, (Bate)

RASCO COUWTT EN31NEERING SERVICES

RageZoTS

Project: Collier Parkway at Uvingston Road InteraecUon lmpro»einents, Pasco County, FL Woik Order Number: X10959 Prpject ID:

Road Name / No. : Collier Parimny/County Una Road and LJvingrton Road

B. Spacial Conditions / Constraints

1: Frontier Relocation Activities will not ccmnnence unta receipt of Approved UWS which created based on Pasco County road plans dated on this UWS him, and Approved Pennits.

2: Fronder Inspector wffl be available for tfae pre-construction meetmg in the field and be the point of contact far Frontier Construction for the Road Contractor for the duration of the project

3: Frontier Woridng Days are during normal business hours, Monday - Friday, 7:30 am - 5:00 pm (excluding Holidays). Frontier will arrange any works after hour with an advance notice flirough Frontier field representative.

4: Frontier facilities that are to remain in place wiU be located and protected during construcdon.

5: The Road Contractor is to notify Frontier Alber Rivas 813-431-2909, 48 hours prior to start of construction.

6: Frontier is to have access throughout the duration of the project to monitor and maintain Frontier facilities for the ability tn provide service.

7: Extreme caution is to be used when excavating near or around Frontier facilities and the road contractor is to contact Frontier 48 hours (Mba-Fri) prior to monitoruig / adjustments during construction.

8: Frontier requests a copy of the CPM iqxm qpproval by Pasco County.

9: Per OSHA Regulations, Frontier will prohibit woA to be perfoimed when adverse weather conditions that would jeopardize the safety of Frontier's crews.

10-Hold/Guari/Protect may mclude the use of sheeting, shoring and bracmg of (FRONTIER) facilities and should be decided upon by Field RepresenMives of (FRONTIER) in coordination with the Departments Contractor on a case by case basis. This by no means relieves the Contractor of its responsibilities as written in Statute 556 and contract documents.

RASGO COUICTY ENGWEERWG SERVICES

Prplect: Collier Parinray at Lhringaton Road IntenecUon Impnxementa, Pasco County, FL Work Order Number: X10959

Road Name / No. : Colliar Paikway/County Line Road and Lhlngaton Road C. DhposlUon of FadlWes (Lit All ExhUng & Propomd) on Prpject

UDUTYFACIUTIESBY DESCRIFnO

STATUS/ N OF

TYPEBIZEfMATERIAUOFFSET UTILITV

TO BASELINE FROM STA TO WORK

STA

FRONTIER RISER, GUY, AND TO BE REMOVED

ANCHOR

ATSTA12+63, 30'RT

PagB3ot3

FRONTIER OH TELE CABLE

FROM STA 12+63, 30' RT TO

STA 16+81, 16'RT

TO BE REMOVED

FRONTIER OH TELE, GUY, AND TO BE REMOVED

ANCHOR

STA 16+81, 16'RT

FRONTIER POLE

ATSTA13+67, 20'RT

FRONTIER BT STUB 600X TO

100XSTA. 12+63, RT 30-

FRONTIER BT RISER 25X

600X TO 100XSTA. 16+81 RT

16'

FRONTIER 2-BT TO BE

ADJUSTED LOWER

FROM STA 14+39. 14'- 15' RT

TO STA 14+82, 12'-15'RT

TO BE REMOVED

TO BE PLACED & SPLICED

TO BE PLACED & SPLICED

TO BE ADJUSTED LOWER

DEPENDE

NT

ACTIVITI

ES

SPLICING OF

RISERS &

STUB

REMOVAL

OF OH

CABLE

APPROVED

UWS&

PERMIT

CONST. ORX

S-2

M.O.

T.

PHAS

E

NUMB

ER

PRIOR TO

CONST.

CONST

DURING

CONSEClm

VE

Rftsco courmr ENGINEERING SERVICES

FRONTIER APPROVAL &

MATERIAL ACQUISITION

4of3

PASCO COUNTY ENGINEERING SERVICES

Project: Collier Parkway at Llvlngston Road IntsraecUon Improvmnenta, P-co County, FL Work Order Number: X10959

Road Name / No. : Collier Parkway/County Line Road and LMng»ton Road

A. Spectrum Summary of Utility Work And ExecuUon

P^plBfS

Total Time Prior to Project Constructton Total Time During Protect Constiucdon

J!_

This document has been developed as the method for a Utility Agency/Owner (UAO) to transmit to Pasco County, the County's Contractor, and othei^right-ofway usere, the location, relocation, adjustment, installation, and/or protactlon of their fadMes, on this linprovement Plan project, "nie fcllowlng data Is baaed on prellmlnaiy construcUon plans dated June 3. 2021 _. Any devlatton by Pasco County or to contractor ftom the plant, aa proulded, may render this worit .chedule null and void. Upon notlflcatton by Paaco County of such change, this utility may require additional days for assessment and negob'atlon of a new woik schedule. This UAO Is not responsible for events beyond the control of the UAO that cuukl not reasonably be antia'pated by the UAO and which could not be avoided by the UAO with the exeidseofdue diligence at the time of the occurrence. The UAO agrees to notify Pa«co County In writing prior to atartlng, stopping, iBauming, or completing woik.

UAO Project Repreaentafhe:

UAO Field RepreientaUve:

Joshua Whte

Joshua White

Telephone Nuinber:

Telephone Numbar:

727-207-9436 727-207At3B

Tliis document Is a printout of a fbim maintained in an electronic foimat and all mviatons thBreto by the UAO In the form of additions, deletions or substitutions am reflected only in an Appsndix entitled "ChangeB to Form Documerrf" and no change Is made In the text of the document Itself. Hand notations on affected portions of this documant may refer to changes reflected In the above-named Appendu but are for reference puipoaes only and do not change tha temia of UIB document By signing this document, the UAO hereby represente that no change has been made to the text of this document except through the terma of the appendix entitled . Changes to Fonn Document"

You MUST signify by wlectlng or checking which of the following applies:

Number of Attachment Pages.

D No changee to fomis document.

l-l Appendix "Changes to Formi DocumenT it attached, Autliorized Utility Agent:

lA/fustJL (SIgnatun)

Joahua White (PrintKlNime)

ConstNctton Coordlmtor

(Title)

82/2/21 (Df)

Epain-r-ofR"cold (EOR):

fgnatun)

SlBuert P. E.

En Inner of Record

^. ^. 2.1

(MB)

e ceb Pas C u giwtum CWfsw^ew- vti6W(?.e ei-lrWaUihniPiC.

(Printed Nani^

A»IT. S><*|. ^situitjE'^» p~ fTIUe)

(Drte)

P^|e2of3

PASOO OOUKTY ENGINEERINQ SHWICE5

Pmject Collier Paikway at Uvlngaton Road Intemectkin Improvamente, Paseo County, FL Work Order Number X10959

Road Name / No.: Collier ParinmyfCounty Line Road and Llvlngaton Road

B. Special Conditions I ConitnlntB right House Networks Contractor will be available during nonnal working hours from 7:30AM to 5:OOPM Monday tfaru Friday, excluding olidays.

y modification and / or deviation ofqiproved schedule may render Bright House Netwoiks approved relocation schedule NULL and VOID.

pon notification of such change, Bright House Networks may require up to 30 days for assessment and negotiation of the new relocation hedule.

HN is a member of Sunshine One Call.

HN can be reached 24 hours, seven days a week at 727-862-0522

PASCO OOUWTY ENGINEERING SERVICES

Pro|ect: Collier Parkway at Living«tmi Road IntemacUon bnprowmentB, Paaco County, FL Walk Order Numben X109S9

Pro|m;tlD:

Road Name I No. : Collier ParimnitfCounty Uno Road and Livlngston Road C. Disposition of Facllitie* (U»t All ExiaUng & Proposed) on Project:

U'nUTV FACIUTIES BY STATUS; DESCRIPTION Tn'EfSIZEflNATCRIAUOFFSETTO OF

BASEUNEFRONSTATOSTA UnUTyWORK

Rage3aT3

U/GCATV2-2"Condu 14+59 R30to 14 +64 R 30

Protect existing infrastructure during excavation and installation of new Endwall and Concrete Ditch

DEPENDENT

ACTIVITIES

Notification and scheduling of activity by team building new Endwall

CONSECUTIVE

PABOO COUNT/ EWGINESIING SERUICES

Project: Collier Parkway at Llvlngston Road Intemectlon Improvement*, Paaco County, FL Woik Order Numben X109S9

Project ID: ED020-038 Road Name / No. : Collier Paikwy/County Uno Road and LMngaton Road

A. Ztyo Group Summaiy of UUIKy Work And Execution

PiB«1nr3

Total Time Prior to Project ConstrucUon Total Time During Project Conatiuctton

This document has been developed as the method for a UtlBty Agency/Owner (UAO) to bansmB to Paaco County, the County's Contrador, and other right-o^way usere, the location, relocation, adjustment, installation, and/or protaction of their facllWet, on thn Improvemsnt Plan proJecL The following data Is based on preliminary consbuclion plans dated Junes. 2021 _, Any deviation by Paaco County or K« contractor from the ptero, a» provided, may render this work schedule null and void. Upon nodflcatlon by Paaco County of such change. Wa utility may mqulre additional days for a«se«sment and negotiation of a n«w woik schedule. Thia UAO Is not responaibto for events beyond the control of the UAO that could not reasonably be anttelpatsd by the UAO and which could not be avoided by the UAO with the exeroise of due diligence at the time of the occuirwice. The UAO agrees to notify Pasco County In writing prior to starting, stopping, resuming, or completing work.

UAO Prelect Representathfe: MattRlchaids UAO Field Representafhe: Teu Ban

Tetsphone Nuinber:

Telephone Number

813.587.2584 813.383.8797

Thl« document Is a printout of a form maintained In an electmnic format and all reviaiom thereto by the UAO in the fbnn of addUona. deletions or substitutions am reflected only In an Appendix entitled 'Changes to Fomi Documenr and no change to made In the text of the document Kaeff. Hand notattona on affected portions of this document may refer to changes reflected In the above-named Appendbt but are for reference purpoaea only and do not change the temrofthe document. By signing thte document, the UAO hereby mpmaenf that no change haa been made to the text of this document except through the terms of the appendix entitled "Changee to Foim Document"

You MUST signify by aelscting or checking which of the foBowing applies;

Q No changes to fomu document.

Q Appendix 'Changes to Foims Document" h attached..

Authorized Utility Agent:

(Slg )

.Number of Attachment Pages.

pord (EOR): ^ Te» Bantavou Jaffmv Stewert. P.E.

(Printed Nmr)

OSP Pmled Manager Cantral PL

(PifntodNun*)

EnalnBBrofRttCord.

|8CO ISltUDtX;

It^ inatum) _ ^ "

£rt?. iSTt>rua*-vi6iCT. P. £.

01..lMUiUdiu^![., Assr. &<t»«a»»'*r SamicC

7/28/21 fritD

(Drt.)

^.\ ^. (Tltto) z- (Df> (0«te|

RftSCO COUNTV ENGINEERING SERVICES

P^|B2nf3

Project CoUler Parkway at LlvlngrtDn Road IntemecUon Impronmenh, Puco Counly, FL Woik Order Numbw: X109S9

Road Name / No.: Collter Paikway/County Line Road and LMngrton Road B. Special Condition* I Conrtralnh

90ntact T®ss Bentayou 72 hours prior to construction at 81 3.363.6797 and for scheduling the adjustment and/or relocation of Zayo facilities during construction.

Zayo requests a copy of the Contractor's work schedule upon approval.

PASOO COUNTY BK31NEERING SERVICES

UTILmr WORK SCHEDULE

Prqlect Collim- Parkway at Livlngston Road IntBiaection Improvemenls, Pasco County, FL Wtork Order Numben X10969

Road Name I No. : CoUler Parinnyreounty Line Road and Lhingrton Road c- Disposition of FaclllUeB (U«t All ExhUng a Propoaed) on Prolact:

UTILITY FACIUHES BY STATUS? DESCRIPTION

TYPE/SIZE/MATCRIAUOFFSETTO OF DEPENDEIfT

BASEUNEFRONSTATOSTA UTILITY WORK ACTIVITIES

(3) 1-1/4" HDPE DUCTS EW

432CT FOC/0+00/22.8' LT to

14+31. 75/17. 4'LT

To Remain None

P^e3ot3

CONSECUTIVE

(3) 1-1/4" HDPE DUCTS BW

432CT FOC/14+31.75/22.8' LT

to 14+89.2/16.r LT

(3) 1-1/4" HDPE DUCTS E/W

432CT FOC/14+89.2/16.7- LT

to 18+68.43/17- LT

Relocate to 24' 8.75" from C/L to accommodate construction of S-1

To Remain

Staking / N/A installation of S-1

None None