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• 3 <br />Witness: <br />Carolina breeti Cqi' <br />Contractor (Trade or Corporate Nrire l <br />By <br />(Proprietorship or Partnership) <br />Attest (Corporation) <br />Title e <br />fires: (ii' �fiG .^ on <br />Qwnef Partner, or Carp - <br />By <br />Title: <br />(Corp.'SeG. orA : _. orxry) <br />(Corporate Seal) <br />CO fi My OF &,MICA <br />(Surety COMP-aft y) <br />• Witness: <br />By: <br />�f =� t <br />Tltles .Donna K. Ash 7: <br />f r <br />Jenni Ho <br />(AttO� rrey in FAct) <br />Gountersagned. <br />lr <br />(Surety. Corporate Seal) <br />Jennifer Hoehn <br />(N. C, Licensed Resident Agent) <br />Wachovia Insurance Services <br />P.O. Boa 220748 <br />Charlotte,-.'RC 28222 _ <br />Name and Address - Soren Agency <br />Travelers Casualty and Surety Co"any <br />of America <br />P.O. Boa 473950 <br />Charlotte, NC 28247 <br />Surety Company Name and N.C. , <br />Regional or Branch Office Address <br />• <br />