Laserfiche WebLink
Page 3 of 5 <br />SURETY'S CONSENT OF PAYMENT TO CONTRACTOR: <br />The Surety, <br />corporation, in accordance with Public Construction Bond Number ,a <br />,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 <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />Corporate Surety <br />Business Address <br />M <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 />upon oath, says that <br />and that he/she <br />by the OWNER to the <br />Payment. Subscribed <br />20 <br />as identification, who being by me first duly sworn <br />he/she is the _ <br />has been authorized by <br />CONTRACTOR of the <br />and sworn to befor <br />for <br />e <br />it to approve payment <br />foregoing Contractor's Application for <br />me this day of <br />Notary Public, State of _ <br />My Commission Expires: <br />[The remainder of this page was left blank intentionally] <br />00622-3 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\0455-8th Street Sidewalk Improvements 18th Ct to Old Dixie\Admim\Addendums\00622 - Contractor's Application for Payment - <br />03-10 rev.doc <br />