Laserfiche WebLink
Page 3 of 5 <br />SURETY'S CONSENT OF PAYMENT TO CONTRACTOR: <br />The Surety, North America Specialty Insurance Company <br />,a <br />corporation, in accordance with Public Construction Bond Number 2269621 , <br />hereby consents to payment by the OWNER to the CONTRACTOR, for the amounts <br />specified in this CONTRACTOR's APPLICATION FOR PAYMENT. <br />TO BE EXECUTED BY CORPORATE SURETY: <br />Attest: <br />Secretary <br />STATE OF FLORIDA <br />COUNTY OF PINELLAS <br />North. America Specialty Insurance Company <br />Corporate Surety <br />650 Elm Street <br />Manchester, NH 03101 <br />Business Address <br />BY:�..-- <br />Print Name: Kevin Wojtowicz <br />Title: Attorney -in -Fact h„d (1a. <br />(Affix Corporate SEAL) .: <br />Before me, a Notary Public, duly commissioned, qualified, and acting, personally appeared <br />Kevin Wojtowicz , to a well known or who produced <br />as identification, who being by me first duly sworn <br />upon oath, says that he/she is the Attorney -in -Fact for North American Specialty Insurance <br />Company and that he/she has been authorized by North American Specialty Insurance <br />Company it to approve payment by the OWNER to the CONTRACTOR of the foregoing <br />Contractor's Application for Payment. Subscribed and sworn to before me this 8th day of <br />October, 2018. <br />JENNIFER BUTTERFIELD <br />quo f 01A MISSION N GGIBU76 blic, tate ommor f <br />EXPIRES Sept 9, 2020 <br />FLOMBONDEDTHROUGH My Commission Expires: <br />RU INSURANCE COMPANY <br />[The remainder of this page was left blank intentionally] <br />00622-3 00622 - Contractors Application for Payment - finil_ainage <br />C:\Usersljstephens.NIELSONBONDS\Desklop\00622 - Contractoes Application for Payment -final retainage.doc Rev. 05/01 <br />