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2. Updated Construction Schedule per Specification Section 01310. <br />Dated <br />M <br />Page 2 of 5 <br />(CONTRACTOR — must be signed by <br />an Officer of the Corporation) <br />Print Name and Title <br />STATE OF FLORIDA (Affix Corporate SEAL) <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 upon oath, <br />says that he/she is the for and that <br />he/she has been authorized by it to approve payment by the OWNER to the <br />CONTRACTOR of the foregoing Contractor's Application for Payment. Subscribed and sworn to <br />before me this day of , 20 <br />Notary Public, State of <br />My Commission Expires: <br />Please remit payment to: <br />Contractor's Name: <br />Address: <br />[The remainder of this page was left blank intentionally] <br />00622 - Contractor's Application for Payment - 03-10 rev.doc <br />OC622 - 2 <br />F:\PubljcWorks\ENGINEERING DIVISION PROJECTS\1638 6th Avenue US -1 to 21st S'.reet Resurfacing (SCOP)\1-Admin\Bids\Bid Documents\Master Contract Documents\00622 - <br />Contractor's Application for Payment - 03-10 rev.doc <br />