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Page 3 of 5 <br />SURETY'S CONSENT OF PAYMENT TO CONTRACTOR: <br />The Surety, <br />,a <br />corporation, in accordance with Public Construction Bond Number , hereby <br />consents to payment by the OWNER to the CONTRACTOR, for the amounts specified in <br />this CONTRACTOR's APPLICATION FOR PAYMENT. <br />TO BE EXECUTED BY CORPORATE SURETY: <br />Attest: <br />Secretary <br />Corporate Surety <br />Business Address <br />BY: <br />Print Name: <br />Title: <br />(Affix Corporate SEAL) <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />Before me, a Notary Public, duly commissioned, qualified, and acting, personally appeared <br />, to me well known or who produced <br />as identification, who being by me first duly sworn <br />upon oath, says that he/she is the for <br />and that he/she has been authorized by it to approve payment by <br />the OWNER to the CONTRACTOR of the foregoing Contractor's Application for Payment. <br />Subscribed and sworn to before me this day of , 20 <br />Notary Public, State of _ <br />My Commission Expires: <br />[The remainder of this page was left blank intentionally] <br />00622 - Contractor's Application for Payment - 03-10 rev <br />00622-3 <br />F:\PublicWorks\ENGINEERING DIVISION PROJECTS\1503-43rd Ave Swk_Airport Dr to 41st St\1-Admin\Bids\Bid Documents\Master Contract Documents\00622 -Contractors <br />Application for Payment - 03-10 rev.doc Rev. 05/01 <br />