Laserfiche WebLink
; I : <br />Page 2 of 5 <br />2. Updated Construction Schedule per Specification Section 01310, and <br />Dated <br />STATE OF FLORIDA <br />COUNTY OF INIalAN-RtVER,..2ThirZte- <br />By: <br />(CONTRACTOR - must be signed by <br />an Officer of the Corporation) <br />Tobt0t4-e. forakii <br />Print Name and Title <br />Before me, a Notary Public, duly commissioned, qualified, and acting, personally appeared <br />'Zak:RA- ito triciteen) who being • by me first duly sworn upon oath, says that he/she is the <br />-Prr of the CONTRACTOR mentioned above and that he/she has been duly <br />authorized to act on behalf of it, and that he/she executed the above Contractor's Application for <br />Payment and Contractor's Certification statement on behalf of said CONTRACTOR; and that all of <br />the statem,ts contain sl herein are true, collect, and complete. Subscribed and sworn to before <br />me this riV• day of •Febezicey 20 17. <br />eatnaittr") <br />is personally known to me or has produced <br />as ide <br />NOTARY PUBLIC: Ctiku. <br />(SEAL) Printed name: hada <br />DAWN EMERY <br />‘11"1:0111n3SION a (x;16,150 <br />I"NI'lltl•S Jarman 2(;. 21,22 <br />Commission No.: <br />Go /4(-1 <br />Commission Expiration: 1,724/ZZ <br />Please remit payment to: <br />Contractor's Name: Advanced Roofing, Inc . <br />Address: 1950 NW 22nd St. <br />Ft. Laudedale, FL 33311 <br />[The remainder of this page was left blank intentionally] <br />00622 - 2 <br />FSPLASIc WoMIENGINEERING OMSION PROJECTS11736 IRC Health Department Roof Replacement Pnaletnt •MMMOSI Docznentalktnter Centred 0ocumentalCC622 - <br />Contractors Applicanon for Payment- 03-10 me doc Rev. 05t01 <br />00622 - Contractor's Application for Payment - 03-10 rev <br />42 <br />