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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 />s <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, 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 />u on oath says that he/she is the for <br />pan.d 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 />—120 <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:\%blic Wadm\ENGIIIF mwo DIvmoN PRGJECf8 im IRC Jafl Compex Roof Replacement Repan' Prolaxll-Admin%id DocmenbWasta Conhad <br />Documents W22 - cwbhaaots Application forPgmcd - 03-10 my doc <br />