Laserfiche WebLink
SURETY'S CONSENT OF PAYMENT TO CONTRACTOR: <br /> The Surety Hartford Fire Insurance Company <br /> a corporation, in accordance with Public Construction Bond Number 21BCSFZ7966 , <br /> hereby consents to payment by the OWNER to the CONTRACTOR, for the amounts <br /> specified in this CONTRACTOR's APPLICATION FOR PAYMENT. <br /> TO BE EXECUTED BY CORPORATE SURETY: <br /> Attest: <br /> As per Attached Power <br /> of Attorney Hartford Fire Insurance Company <br /> Secretary Corporate Surety <br /> One Hartford Plaza <br /> Hartford, CT 06183 <br /> Busine s Ad,1171 , <br /> BY: <br /> Prin me: C rle J. Nielson <br /> Title: Attorney In Fact <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 <br /> appeared Charles J. Nielson , to me well known or who <br /> produced personally known as identification, who being by me <br /> first duly sworn upon oath, says that he/she is the Attorney In Fact <br /> for Hartford Fire Insurance Company and that he/she has been authorized by <br /> it to approve payment by the OWNER to the CONTRACTOR of the foregMA/161 <br /> Contractors Application for Payment. Subscribed and sworn to before, <br /> i�, <br /> 13th day of February <br /> -, 20 13 �,���:•�pNEXPjA'•• �.,, <br /> Fs; <br /> �•� e14,2py� �s.o <br /> No ary Public, State-6f Florida <br /> My Commission Expires: 11/14/13 <br /> [The remainder of this page was left blank intentionally] <br /> Last Revised 2-16-2012 Application for Payment Form <br /> 00622-3 <br /> LACIose Projects-Current\586-Egret MarsMPay Appiications�Application for Payment Form.doc Rev.05101 <br /> 41 <br />