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Page 2 of 5 <br />2. Updated Construction Schedule per Specification Section 01310, Wd <br />Dated 5/29/18 By: — M /Zz <br />(CONTRACTO — mus b s ed by <br />an Officer oft a Corporation) <br />Daniel Duke III, 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 />Daniel Duke III who being by me first duly sworn upon oath, says that he/she is <br />the President of the CONTRACTOR mentioned above and that he/she has <br />been_duly authorized to act on behalf of it, and that he/she executed the above Contractor's <br />Application for Payment and Contractor's Certification statement on behalf of said CONTRACTOR; <br />and that all of the statements contained herein are true, correct, and complete. Subscribed and <br />sworn to before me this 29th day of May 2018 <br />_Daniel Duke III is personally known to me or <br />as identification. <br />NOTARY PUBLIC: <br />Vrt r Notar=R Public State of Florida <br />(SE Chase R Rogers Printed name: _Chase oger <br />�j My Commission FF 932543 <br />f Expires 11/02/2019 Commission No.: FF 932543 <br />Commission Expiration: _11/02/2019 <br />Please remit payment to: <br />Contractor's Name: _Hinterland Group, Inc. <br />Address: 2051 W. Blue Heron Blvd. <br />_Riviera Beach, Florida 33404 <br />[The remainder of this page was left blank intentionally] <br />Contractor's Application for Payment <br />00622-2 <br />MG-SERVER1Hinterland GrouplDropbox (Hinterland Group)WAarded Projects MM007-00 -Indian River -Blue Cypress Lake Road Culvert Replacemenl\Pay ApplicationlPgyp <br />No. 21Conlractors Application for Payment.doc Rev. 05!01 <br />