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Page 3of5 <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 /> URETY: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 /> 20 <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\08458-Old Dixie Hwy Sidewalk(38th Ln-45th SQ)Admim\bid documents\Master Contract Documents\00622-Contractor's <br /> Application for Payment-03-10 rev.doc Rev.05/01 <br />