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Page 3 of 5 <br /> SURETY' 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 /> Secretary Corporate Surety <br /> Business Address <br /> BY: <br /> Print Name : <br /> Title : <br /> (Affix Corporate SEAL) <br /> STATE OF FLORIDA <br /> COUNTY OF INDIAN RIVER <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 /> 201 <br /> Notary Public , State of <br /> My Commission Expires : <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\1102-Old Dixie Hwy Swk 8th St to SR 60-LAPWdmim\bid documents\Master Contract Documents100622 - Contractor's <br /> Application for Payment - 0310 rev.doc Rev. 05101 <br /> I <br />