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(TO ACCOMPANY_ CONTRACTOR'S FINAL APPLICATION FOR PAYME <br />PROJECT NAME: _CR 512 RESURFACING (EAST BOUND ONLY) (ROSELAND ROAD <br />IRC PROJECT NO: 1132 <br />STATE OF Florida <br />COUNTY OF Orange <br />Personally before me the undersigned officer, authorized by the laws of said state to <br />administer oaths, comes F. Scott Fowler who on oath says: That he is the <br />CONTRACTOR with whom Indian River County, Florida, a political subdivision of said state, <br />did on the 14 day of May ,2013 , enter into a contract for the performance of certain <br />work, more particularly described as follows: <br />UNDER PENALTY OF PERJURY, affiant further says that said construction has <br />been completed and the Contract therefore fully performed and final payment is now due <br />and that all liens of all firms and individuals contracting directly with or directly employed by <br />such CONTRACTOR have been paid in full EXCEPT: <br />who have not been paid and who are due the amount set forth. <br />Affiant further says that: <br />1. CONTRACTOR has reviewed the Contract Documents. <br />2. CONTRACTORhasreviewed the Work for compliance with the Contract <br />Documents, <br />3. CONTRACTOR has completed the Work in accordance with the Contract <br />4. All equipment and systems have been tested in the presence of the ENGINEER or <br />his representative and are fully operational with no defects or deficiencies except as <br />GAGontractAdmiWOBS-Mt}NIGIPAMY13505W2 CR 512100632 Contractors FInai Cer ificaiion REV 04-07.doe <br />SmeadSoft Reprint Dater Wednesday, December 14,2016 - 11:52:35 - BCC:1826 Attachment Id 1, Page 28 <br />