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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 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 the OWNER <br />to the CONTRACTOR of the foregoing Contractor's Application for Payment. Subscribed and <br />sworn to before me this day of , 20 <br />Notary Public, State of <br />My Commission Expires: <br />******************************************************************************************************* <br />[The remainder of this page was left blank intentionally] <br />Contractor's Application for Partial Payment - 06-09 rev - 00622 - 3 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1639 69th Street 66th Avenue to US -1 Resurfacing (SCOP)\7-Admin\Bids\Bid Documents - Advertisement\DN 0_IBidding Documents - <br />20210924.docx <br />