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(TO ACCOMPANY CONTRACTOR'S FINAL APPLICATION FOR PAYMENT) <br />PROJECT NAME: Gifford Neighborhood 45"' Street Beautification Prolect <br />_. IRC PROJECT NO: 1506 <br />STATE OFOr 1 CEG. <br />COUNTY OF <br />Personally before me the undersigned officer, authorized by the laws of said state to <br />administer oaths, comes 'we-.- Land S7cr, I rk , who on oath <br />says: That he is the CONTRACTOR with whom In Ian River aunty, Florida, a political <br />subdivision of said state, did on the 10 day of S f— ,2Q -ISL, enter <br />into a contract for the performance of certain work, more 0drficularly described as follows: <br />S-l-.jiLu.�-ti rte, v>-.� �Qc� 1 So lP <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 alt firms and individuals contracting directly with or directly employed by <br />such CONTRACTOR have been paid in full EXCEPT: <br />Name Description/Amount <br />I Ghcon(-(p <br />who have not been paid and who are due the nount.set forth. <br />Affiant further says that: <br />1. CONTRACTOR has reviewed -the Contract Documents. <br />2. CONTRACTOR has reviewed the Work for compliance with the Contract <br />-- Documents. <br />3. CONTRACTOR has completed the Work in accordance with the Contract <br />Documents. <br />4. All equipment and systems have been misted in the presence of the ENGINEER or <br />his representative and are fully operational with no defects or deficiencies except as <br />listed below. <br />OOn2-1 <br />R)Pubde WorkslENGiNEERING DIVISION PROJECTS\1508-Gin"aro Neloftrhood 45th St 89mMcaIion%AdminlbM doeumantsvAsster <br />Contract DocumentsNOM2 - Contradors Final CoMoadon REV 04.07.doc <br />P30 <br />