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r <br /> ' TO BE EXECUTED BY CORPORATE SURETY : <br /> Attest: :. . <br /> r 4= <br /> Secretary Corporate Surety <br /> 1 <br /> r <br /> Business Address <br /> ' BY : <br /> Print Name : <br /> Title : <br /> rSTATE OF FLORIDA (Affix Corporate SEAL ) <br /> COUNTY OF INDIAN RIVER <br /> Before me , a Notary Public , duly commissioned , qualified and acting , personally <br /> appeared , to me well known , who being by <br /> me first duly sworn upon oath , says that he is the <br /> for and that he has been authorized by <br /> it to approve payment by the OWNER to the CONTRACTOR of the foregoing <br /> Contractor' s Application for Payment. Subscribed and sworn to before me this <br /> day of 2p <br /> rNotary Public , State of Florida <br /> My Commission Expires : <br /> [The Remainder of This Page Was Left Blank Intentionally] <br /> r <br /> r <br /> 1 <br /> r <br /> r <br /> 00622 - Contractor's Application for Payment ADDENDUM #1 — ADDENDUM #1 <br /> 00622 - 3 <br /> F:\Public WorksWeithWstonnwater Projects\Gifford ESSAConstruction Contract\Bidding & Contract Documents\aldding & Contract Documents\00622 - Contractors Application <br /> for Payment ADDENDUM #1 .doc Rev. 05/01 <br />