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-"i <br />- <br />Page 3 of 5 <br />SURETY'S CONSENT OF PAYMENT TO CONTRACTOR: <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 />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />(Affix Corporate SEAL) . <br />Before me, aNotary 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 - Contractors Application for Payment - 03-10 rev <br />00622 - 3_ <br />F.\Public WorkstENGINEERING DIVISION PROJECTS11736 IRC Health Department Root RePlacemenl Projedtl,Admin\Bid DooumenteNdater Contract Documents100622 - <br />ConUactofs Application for Payment -03-10 rev,dob Rev, 05101 <br />