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SIGNED and SEALED this <br />day of 2009. <br />PRINCIPAL IMPORTANT NOTICE <br /> An individual doing business <br />(SEAL OF PRINCIPAL) By: under a firm name mustgive both <br /> names, and the individual shall <br />Title: designate himself as sole owner. <br /> If a partnership, so state, and at <br /> 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 officer <br /> of the corporation. <br />(SEAL OF SURETY) By: <br />Title: Any other person executing for <br /> the principal or surety must at- <br /> tach apower of attorney. <br />COMPLETE MAILING ADDRESS <br />NOTICE TO SURETY <br />Section 26.1-03-01, N.D.C.C. Provides: <br />"Limitation on risks acceptable by company. An insurance company transacting an insurance business in this <br />state may not expose itself to loss on any one risk or hazard to an amount exceeding ten percent of its paid-up capital <br />and surplus if a stock company, or ten percent of its surplus if a mutual company, unless the excess is reinsured." <br />If excess reinsurance agreements are required on this bond, an affidavit executed by an officer of the surety shall be <br />attached, stating that such reinsurance agreements have been entered into and are in effect at the time the bond is <br />executed, giving the name an address of all companies with whom such agreements have been entered, and that <br />copies of such reinsurance agreements will be furnished to the North Dakota commissioner of insurance. <br />ACKNOWLEDGMENT OF PRINCIPAL <br />State of <br />County of <br />On this- <br />be <br />personally appeared <br />known to me to <br />(title) of the principal described in the within instrument and who executed the <br />same and acknowledged to me that the same was executed for and on behalf of said principal. <br />Notary Public, State of <br />(Notary Public must print or type name here.) <br />My Commission expires <br />ss. <br />ay of 2009, before me a notary public in and for the state of <br />(NOTARY SEAL) <br />2of3 <br />