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Page 3 of 5 <br />S URETY'S CONSENT OF PAYMENT TO CONTRACTOR: <br />The Surety, <br />,a <br />corporation, in accordance with Public Construction Bond Number , hereby <br />consents to payment by the OWNER to the CONTRACTOR, for the amounts specified in <br />this CONTRACTOR's APPLICATION FOR PAYMENT. <br />TO BE EXECUTED BY CORPORATE SURETY: <br />Attest: <br />S ecretary Corporate Surety <br />S TATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />Business Address <br />BY* <br />Print Name. <br />Title: <br />(Affix Corporate SEAL) <br />Before me, a Notary Public, duly commissioned, qualified, and acting, personally appeared <br />to me well known or who produced <br />as identification, who being by me first duly sworn <br />upon oath, says that he/she is the for <br />and that he/she. has been authorized by it to approve payment <br />by the OWNER to the CONTRACTOR of the foregoing Contractor's Application for <br />Payment. Subscribed and sworn to before me this day of <br />,20 <br />Notary Public, State of <br />My Commission Expires: <br />**************************************************************************************************** <br />[The remainder of this page was left blank intentionally] <br />00622 - Contractor's Application for Payment - 03-10 rev.doc <br />00622 - 3 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1213-IRC Shooting Range -Skeet & Trap Improvemnts & Hunters Train Bldg\Admim\bid documents\Contract Documents\00622 <br />- Contractor's Application for Payment - 03-10 rev.doc Rev. 05/01 <br />