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Dated: 09/05/18 <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />By: <br />TRACTOR - must be signed <br />Timothy Rose, President <br />Print Name and Title <br />Before me, a Notary Public, duly commissioned, qualified, and acting, personally appeared <br />Timothy Rose, who being by me first duly sworn upon oath, says that he/she is the President of <br />the CONTRACTOR mentioned above and that he/she has been duly authorized to act on behalf <br />of it, and that he/she executed the above Contractor's Application for Payment and Contractor's <br />Certification statement on behalf of said CONTRACTOR; : and that all of the statements <br />contained herein are true, correct, and complete. Subscribed and sworn to before me this 6th <br />day of September, 2018 <br />Timothy Rose is personally known to me or has produced as identification.. <br />NOTARY PUBLIC: <br />(SEAL).,; <br />vo3,r Printed name: Deborah West <br />j a c <br />03.:019 tt <br />Commission No: FF904578 <br />Commission Expiration: 10.03.19 <br />Please remit payment to: <br />Contractor's Name: Timothy R • e Contracting <br />Address: 1360 SW Old Dixie Hwy Suite 106 <br />Vero Beach FL 32962 <br />tt*w•�f*t�,t,ea+nt,r.t:warms r*+�*�*�ar�r:t�Ytt�rr:rrtn:�:rar�er:e3,tt r,tx tottstsstttt*ett'xs,tetrxfeexxxt,efnesststttt+it+wx�tx+exx+ri <br />[The remainder of this page was. left blank intentionally] <br />00622-2 <br />41 <br />