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2. Updated Construction Schedule per Specification Section 01310, and <br />Dated By: <br />STATE OF FLORIDA <br />COUNTY OF INDIAN RIVER <br />Page 2 of 5 <br />(CONTRACTOR — must be signed by <br />an Officer of the Corporation) <br />Print Name and Title <br />Before me, a Notary Pub|ic, duly conlnnissioned, qua|ified, and actng, personally appeared <br />. who being by me first duly sworn upon oath, says that he/she is the <br />of the CONTRACTOR mentioned above and that he/she has been duly <br />authorized 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 herein are true, corneot, and complete Subscribed and sworn to before <br />me this day of .2O____ <br />is personally known to me or has produced <br />as identification <br />(SEAL) <br />NOTARY PUBLIC: <br />Printed name <br />Commission No <br />Commission Expiration <br />[The remainder of this page was left blank intentionally] <br />00622 Contractors AppUcation for Payment 03-10 rev <br />00622 2 <br />F`r"m.ovm*s \ ENGINEERING DIVISION PROJECTS ,z05v"=Lake Estates o°1,on^m_,o,*Ave mon5,o/oP»xurn."m.^^"=="muw"".°,Contract Documents n0622 <br />