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SURETY'S CONSENT OF PAYMENT TO CONTRACTOR: <br />The Surety, WESTFIELD INSURNCE COMPANY <br />,a <br />corporation, in accordance with Public Construction Bond Number 5091445 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 jV <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />WESTFIELD INSURANCE COMPANY <br />Corporate Surety <br />One Park Circle, P.O. Box 5001 <br />Westfield Center, Ohio 44251-5001 <br />Business ss <br />BY' s <br />lnt Name:. Cabot W. Lord <br />Title: Attorney-in-fact <br />(Affix Corporate SEAL) <br />Before me, a Notary Public, duly commissioned, qualified, and acting, personally appeGred <br />Cabot W. Lord , to me well known or who produced <br />personally known as identification, who being by me first duly sworn <br />upon oath, says that he/she is the Attorney -in -Fact for <br />Westfield Insurance Co and that he/she has been authorized by,Westfield Insurance Coit 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 28th clay of <br />Jule , 20 17 <br />I <br />o1 Not+�ryP�elicstateofFtorwa Notary Public, State of 1=L <br />�,,p' My Commission FF 171767 My Commission Expires: ii -.1i -M <br />j =Fa¢Rires 11121/2018 <br />[The remainder of this page was left blank intentionally] <br />00622 - Contractors Application for Payment • 03-10 rev <br />00622-3 <br />F:1Public WorkMENGINEERING DIVISION PROJECTMID49 8th St Sidewa& Improvements (58th Ave to 21st Court)IAdmimUd documentsllAP Dontmen"aster Con"d <br />Documents100622 - Contractor's Application for Payment- 0910 rev.doc Rev. 05101 _ 117 <br />