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Page 2 of 6 <br />2. Updated Construction Schedule per Specification Section 01310, and <br />Dated\.GR- ady <br />STATE OF FLORIDA <br />COUNTY OF AtegikN=RIVER <br />Print Name and Title <br />Before me a otary Public, duly commissioned, qualified, and acting, personally appeared <br />aw who being by me first duly swom upon oath, says that he/she is the <br />e.�-- of the CONTRACTOR mentioned above and thatc he has been duly <br />authorized to act on behalf of it, and that he/she executed the above Contractor's Application for <br />Payment and Contractor's Certification statement on behalf of said CONTRACTOR; and that all of <br />the statements contained herein are true, correct, and complete. Subscribed and swom to before <br />me this day of-a>vugeAl , 20,1 . <br />is personally known to me or has produced <br />as idenfi►.tion. <br />t}S�aiiEt4fezP6�y1 <br />P <br />(SEAL)-6')/ <br />�a 'rss <br />a0� (\\ 19, 20 9 ` <br />4 9 ``m • <br />******** <br />#EE 154184 ; <br />>9.0.6 4? BondedlhN t.7 9$*- <br />f fe jisq/c <br />A�ae�aSk4t�!4t```' <br />NOTARY PUBLIC: <br />Printed name: ckg6T, <br />Commission No.: EE 1S`l S`\ <br />Commission Expiration: 4 19 % 110 <br />[The remainder of this page was left blank intentionally] <br />00622 -2 <br />00622 - Contractor's Application for Payment - 03-10 rev.doc <br />•..._ ...--...... 111•..r...^..1 oon .crrv.. et...a nam. .ia,•7nn Rn,eolarl RA to Fasv St -SEE PROJ 09261AdmimlOontiaet Doclltoents1001322 - Contractors <br />24 <br />