Laserfiche WebLink
Page 2 of 5 <br />2. Updated Construction Schedule per Specification Section 01310, and <br />Dated 10/05/2018 By: <br />��PG ..... % (CONTRA TO — must be signed by <br />•`' '• �� : an Officer(of the Corporation) <br />C� CooRPol?4 C� <br />Z —•-- F : m <br />� <br />SEAL <br />T Z _ Myra Smith, Vice President <br />►J 1'LL ; .n, Print Name and Title <br />STATE OF FLORIDA1gg4 <br />COUNTY OF INDIAN RIVER F�ORIOP <br />Before me, a Notary Public, duly commissioned, qualified, and acting, personally appeared <br />Myra Smith, who being by me first duly sworn upon oath, says that she is the Vice President of the <br />CONTRACTOR mentioned above and that he/she has been duly authorized to act on behalf of it, <br />and that she executed the above Contractor's Application for Payment and Contractor's Certification <br />statement on behalf of said CONTRACTOR; and that all of the statements contained herein are <br />true, correct, and complete. Subscribed and sworn to before me this 5th day of October, 2018. <br />Myra Smith, Vice President is personally known to me. <br />NOTARY PUBLIC: <br />(SEAL) Printed name: Wanda Sue Smart <br />WANDA SU@SMART Commission No.:GG200367 <br />o1*PY PUB <br />? •' commisslon#GG200367 Commission Expiration: 04/25/2022 <br />Expires April 25, 2022 <br />�9rF0Pe1.v, Bonded ThruBudpotNOWServloes <br />Please remit payment to: <br />Contractor's Name: Mancil's Tractor Service, Inc. <br />Address: 8530 SW Jayme Way <br />Palm City, FL 34990 <br />[The remainder of this page was left blank intentionally] <br />130 <br />RETAINAGE COVER PAGE <br />00622-2 <br />M:10owments\WORK FILES%CR510 85TH STREET RIGHT TURN LANE EXTENSIOMPAY APPLICATIONS\RETAINAGE COVER PAGE.doc Rev. 05/01 <br />