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Page 3 of 5 <br /> SURETY'S CONSENT OF PAYMENT TO CONTRACTOR: l <br /> ; <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 /> 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 <br /> 00622-3 <br /> F\Public Works\ENGINEERING DIVISION PROJECTS\1619 Round Island Facility Paving\1-Admin\bid documents\Master Contract Documents\00622-Contractors Application for <br /> Payment-03-10 rev.doc Rev 05/01 <br />