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<br />EXECUTED the date last below signed. <br /> <br />WITNESS: <br /> <br />NAME (TYPE OR PRINT) <br /> <br />SIGNATURE <br /> <br />To be signed by Owner; Partner; Corp. Pres., Vice <br />Pres., or other authorized Corp. Officer. (If signed <br />by other authorized Corp. Officer, please attach <br />copy of Power of Attorney or other documentation <br />showing authority to sign.) <br /> <br />WITNESS: <br /> <br />NAME (TYPE OR PRINT) <br /> <br />SIGNATURE <br /> <br />DOT 16870 (Div. 09) <br />A.G. Approved 7-17-89; 9-06 <br /> <br />5 of 5 <br /> <br />CONTRACTOR: <br /> <br />NAME (TYPE OR PRINT) <br /> <br />SIGNATURE <br /> <br />TITLE <br /> <br />DATE <br /> <br />NORTH DAKOTA <br />DEPARTMENT OF TRANSPORTATION <br /> <br />DIRECTOR (TYPE OR PRINT) <br /> <br />SIGNATURE <br /> <br />DATE <br /> <br /> <br />DATE <br /> <br />DOT 16870 (Div. 09) <br />