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The Contractor hereby agrees to the terms as set forth in this Agreement and hereby acknowledges receipt of this <br />Agreement and of the insurance certificate forms (Exhibits A & B) herein provided. <br />(Name of Contractor) <br />(Address) <br />(Telephone) <br />(Fax) <br />(Signature) <br />(Print Name) <br />(Title) <br />(Contractor's State License No.) <br />Receipt of the foregoing agreement and certificated of insurance furnished by the Contractor are hereby <br />acknowledged on this day of 20 <br />SOUTHERN CALIFORNIA REGIONAL RAIL AUTHORITY <br />By: <br />Right of Way Engineer <br />By: <br />Manager Public Projects <br />[Approved As To Form By Legal Counsel] <br />SCRRA FORM NO. 6 Page 8 of 13 Rev. 9/18/06 <br />