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Updated 3/2019 <br />SIGNED and SEALED this day of 2024. <br /> <br /> <br />PRINCIPAL IMPORTANT NOTICE <br />An individual doing business <br />(SEALOF PRINCIPAL) By: under a firm name must give <br /> both names, and the individual <br /> Title: shall designate himself as sole <br />owner. <br /> <br />If a partnership, so state, and <br /> at least one member of such <br /> partnership must sign. <br />SURETY <br /> If a corporation, the full corpo- <br /> rate name must be used and <br /> COMPLETE MAILING ADDRESS the execution must be by an <br /> officer of the corporation. <br />(SEAL OF SURETY) By: Title: Any other person executing for the principal or surety must at- tach a power of attorney. COMPLETE MAILING ADDRESS <br />NOTICE TO SURETY <br />Section 26.1-03-01, N.D.C.C. Provides: <br /> <br />"Limitation on risks acceptable by company. An insurance company transacting an insurance business in this state may not <br />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 <br />company, or ten percent of its surplus if a mutual company, unless the excess is reinsured." <br /> <br />If excess reinsurance agreements are required on this bond, an affidavit executed by an officer of the surety shall be attached, <br />stating that such reinsurance agreements have been entered into and are in effect at the time the bond is executed, giving <br />the name an address of all companies with whom such agreements have been entered, and that copies of such reinsurance <br />agreements will be furnished to the North Dakota commissioner of insurance. <br /> <br />ACKNOWLEDGMENT OF PRINCIPAL <br /> <br />State of <br />ss. <br />County of <br /> <br />On this day of 2024, before me a notary public in and for the state of <br /> , personally appeared , known to me to be <br />(title) of the principal described in the within instrument and who executed the same and acknowledged to me that the same <br />was executed for and on behalf of said principal. <br /> <br /> <br /> <br />2 of 3 <br />