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SIGNED and SEALED this day of 2014. PRINCIPAL IMPORTANT NOTICE An individual doing business (SEAL OF PRINCIPAL) By: under a firm name must give both names,and the individual shall Title: designate himself as sole owner. If a partnership,so state,and at least one member of such partnership must sign. SURETY If a corporation,the full corpo- rate name must be used and COMPLETE MAILING ADDRESS the execution must be by an officer of the corporation. (SEAL OF SURETY) By: Title: Any other person executing for the principal or surety must at- tach a power of attorney. COMPLETE MAILING ADDRESS NOTICE TO SURETY Section 26.1-03-01, N.D.C.C. Provides: "Limitation on risks acceptable by company. An insurance company transacting an insurance business in this state may not expose itself to loss on any one risk or hazard to an amount exceeding ten percent of its paid-up capital and surplus if a stock company, or ten percent of its surplus if a mutual company, unless the excess is reinsured." If excess reinsurance agreements are required on this bond, an affidavit executed by an officer of the surety shall be attached, stating that such reinsurance agreements have been entered into and are in effect at the time the bond is executed, giving the name an address of all companies with whom such agreements have been entered, and that copies of such reinsurance agreements will be furnished to the North Dakota commissioner of insurance. ACKNOWLEDGMENT OF PRINCIPAL State of ss. County of On this day of 2014, before me a notary public in and for the state of , personally appeared , known to me to be (title) of the principal described in the within instrument and who executed the same and acknowledged to me that the same was executed for and on behalf of said principal. Notary Public, State of (NOTARY SEAL) (Notary Public must print or type name here.) My Commission expires 2 of 3