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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 />STATE OF <br />COUNTY OF <br />Corporate Surety <br />Business Address <br />BY: <br />Print Name: <br />Title: <br />(Affix Corporate SEAL) <br />Sworn to (or affirmed) and subscribed before me by means of ❑ physical presence or ❑ online <br />notarization, this day of 20 , by (name of person <br />making statement). <br />(Signature of Notary Public - State of Florida) <br />(Print, Type, or Stamp Commissioned Name of Notary Public) <br />❑ who is personally known to me or ❑ who has produced <br />as identification. <br />[The remainder of this page was left blank intentionally] <br />Contractor's Application for Partial Payment - 06-09 rev - 00622 - 3 <br />FAPublic Works\ENGINEERING DIVISION PROJECTS\2022 4th St Culvert Replacement at 90th Ave\1-Admin\Bids\Bid Documents\DIV 0 3 Contract Forms - 20201118.docx <br />