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Page 3 of 6 <br />SURETY'S CONSENT OF PAYMENT TO CONTRACTOR: <br />The Surety, <br />Travelers Casualty and Surety Company of America , a <br />corporation, in accordance with Public Construction Bond Number 105907109 , 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 />Travelers Casualty and Surety Company of America <br />Witnesq Corporate Surety <br />One Tower Square <br />Business Addf <br />BY: <br />STATE OF FLORIDA <br />COUNTY OF IND ER OAc1.o <br />Print Na <br />Title: Att <br />08183 800/242-8734 <br />(Affix Corporate SEAL) <br />Before me, a Notary Public, duly commissioned, qualified, and acting, personally appeared <br />William Phelps , to me well known or who produced <br />personally known as identification, who being by me first duly swom <br />upon oath, says that she is the Atlomey-In-Fact for T1& 1cssuaMandSureycor anyoran.nce <br />and thatdrshe has been authorized by T-�•�-��•ac••«we 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 \ s -'day of <br />\ ,20\y . <br />��\t�r ;ill 1111 <br />L,,4y;�P�Y L.I,,.qq' r. <br />J I ,o`i <br />ry Pu , State of .:' .. r _;�,a ts, 2� r��.• <br />My Com sion Expires:A2 s 9 <br />:*y <br />o 2EE 154184 • Q.w <br />************tA*it***nt****************#***AA*AAA*i*Air**14**1**A***************t*irstnk*k*****1********/r�rf'� •�iided 01A b%iC lfidCN`;�••��t�`. <br />[The remainder of this page was left blank intentionally] <br />00622 - Contractor's Application for Payment - 03-10 rev <br />00622 - 3 <br />F.1Pablc works)ENGINEERING DIVISION PROJECTS I132 -CR 512 Ebnd Asarradrg RoseI nd Rd b Easy SI -SEE PROJ (281Adni r1Carirerl Doarn.nb125622 -Convectors <br />AmIkation lot Payment - 03.10 tsv.doe Rev. D5101 <br />25 <br />