Laserfiche WebLink
2. Updated Construction Schedule per Specification Section 01310. <br />Dated 11-1aah o a 6 By: <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />Page 2 of 5 <br />(Ct3NTRACTOR`-- must be signed by <br />an Officer of the Corporation) <br />Print Name and Title <br />Before,, e,J�,,aa Notary Public, duly commissioned, qualified, and acting, personally appeared <br />c)q, 4a • rNai , who being by me first duly sworn upon oath, says that he/she is the <br />CDW40 -cam • of the CONTRACTOR mentioned above and that he/she has been duly <br />authoriked 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 statements contained her In are true, correct, and complete. Subscribed and sworn to before <br />me this .a day of , 20A 0: <br />15A44� 4'.1161435 is personally known to me or has produced <br />aridunttfreNTR5h. <br />(SEAL) <br />• a.w <br />t. 60100169 Q& <br />ip�-$0/1111111110 <br />�`� <br />Please remit payment to: <br />NOTARY PUBLIC: YeGAG <br />Printed name: V f2.CGe. k%O !C/�'YIti J <br />Commission No.: <br />Commission Expiration: <br />Contractor's Name:: RIO-BAK CORPORATION <br />Address: <br />12773 W. FOREST HILL BLVD. SUITE 210 <br />WELLINGTON, FL 33414 <br />*** k*****ih*7 ****it******7k** R** ktk*********** k* INit**7k*****f ******tk***At*******7k*** k**7k********fk**ih***** k <br />[The remainder of this page was left blank intentionally] <br />00622 - 2 <br />f:Vlcltvo ProjocIAVERO BEACH REOTOREIOILLINQIIRC•1023 PAYAI'P 5400 Rov. 05101 <br />IRC-1923_PAYAPP 6.doc 18 <br />