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2. Updated Construction Schedule per Specification Section 01310, and <br />Dated 07/26/17 By:_,401�� ------ �: <br />('f II ACTOR — must be signed by <br />an Officer of the Corporation) <br />Timothy Rose, President <br />Print Name and Title <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />Before me, a Notary Public, duly commissioned, qualified, and acting, personally appeared <br />Timothv Rose, who being by me first duly sworn upon oath, says that he/she is the President of the <br />CONTRACTOR mentioned above and that he/she has been duly authorized to act on behalf of it, <br />and that he/she executed the above Contractor's Application for Payment and Contractor's <br />Certification statement on behalf of said CONTRACTOR; and that all of the statements contained <br />herein are true, correct, and complete. Subscribed and sworn to before me this 26 day of <br />Jam, 2017 <br />Timothv Rose is personally known to me or has produced <br />as identification. <br />NOTARY PUBLIC: <br />SEAL yet; 3T a <br />)Gse S�g,o iFF9045i inted name: Deborah West <br />x 0aaber03,2019 Commission No: FF904578 <br />Commission Expiration: 10.03.19 <br />Please remit payment to: <br />Contractor's Name: Timothy Rose Contracting <br />Address: 1360 SW Old Dixie Hwy Suite 106 <br />Vero Beach FL 32962 <br />[The remainder of this page was left blank intentionally] <br />Cover Page - J16pp 7 i <br />00622-2 i <br />CAUsers\Debbie\Documents\8th Street Sidewalks from 58th Ave to 21st Court\Cover Page -Pay App Tdoc Rev. 05/01 <br />f' <br />