|
DocuSign Envelope ID:29F350EB-C553-4EEB-BD97-898B3775EE03
<br /> ACKNOWLEDGEMENT OF PRINCIPAL—IF A CORPORATION
<br /> }
<br /> STATE.OF , :: .. ,;. S'- .
<br /> COUNTY 0 . .:} .
<br /> O is. .:.,.... . .day. o .., .4.��/�✓.... before me personalty appeared
<br /> to be known,vir i bie �by tite duly sw o,.di epose and say;that h ?`she
<br /> r ides at e : •P! • .. �., that .helsfid is. the .Cl . . .......... ... of
<br /> :. ,.. :..,:,.:.. e:co tip�jr scribed_in and which executed the within insurance
<br /> rPiR .;.
<br /> instrutxteii; thai-held ..:#v►�ws..tieseal`p ` t;i�1:6jot#pn; that 'the seal affixed to said instrument is such
<br /> corporate.:seal; that..is was,86,4T xed`$y ctors of said corpgratiion; and that he/she signed
<br /> his/her'name thereto by like order, 0 TA..p :
<br /> v?7� U.BL.I
<br /> AGtCtVdW1iF.DGrEIN:T FEIAI;',.IF:LiMITED.LtABtLI7Y COMPANY
<br /> S PATE OF:..•. ..:;�, .:,:.i;.: SS
<br /> COUNTY 0 :
<br /> ::. . f
<br /> On: .his::.: 'day:of ally
<br /> :. .. o
<br /> ap' :. 1leari5+.'l::•Y••:,•,::,•rr:iis�1,•'v.:. ..i.'.y:..: ii.,,:'.:•t
<br /> ::.
<br /> Y i
<br /> ,.::. ,...: to me:known.srid known:tq met be the
<br /> Zo
<br /> ' Liilnited I.uabitlty t'pmpahy,_deteti6ed i:n once rvho executed tit foregigg';irisiranc;.instnmetf.aitd'acknowledged tome
<br /> .that htlshg.arkecuta the foteggitlg In �irarice instrument sil-d:ecaeno�vle-ged to ine that he/she exeeutcil the same as'and for
<br /> the aet and deekl: f sand:Ltmttc 'I.iabrlity Company,
<br /> AGI4NO .EDOMNT O St7RET'Y:CQMPANY
<br /> NEW YpRic;.:
<br /> STATE.
<br /> .:,.,..,,P,;: .;:��,.� _. . .
<br /> as vaiix x�;: sa;:.: _ SU$A$'iivpsxz:
<br /> ' Ott..this' •+.fk-.•-•.. .H•,.�•.•.`::-,'f'::,:•'.:,•,,,:`rr _
<br /> fdre;rtie::persona�lly:came..:;•.:,...:..,:::.......,..::,:,... ' .. '
<br /> to'. me: 1eWn ,: wlx�_:'.bgi#isp. me: .du1 !:. tvait depose and- ahat: atelshc: :resides in
<br /> r>ASSAU a.. . Tv QI' at helib,&t the ftnrne in-Fact
<br /> ........,',..,..,. 14n?, ,r 1 ,:State :NewYbtk, -
<br /> Y
<br /> ARCH;fNSURANe9 0M ANY `�. in:W ch:e�ncuted the
<br /> afthe:.,,.... •...:. ,_..;,.�i:,,..a::;...:.....',...'.:r•:,,:,y5 .:.r..i::.Ul
<br /> . .. ...
<br /> e.cortiratioit`desaibed`. hi
<br /> above ins.tianue t :that i el she ltnavv�:thq.seal t�f said c(.rpaiatioii;that the seal a "used.to saidi inst ument is such.
<br /> :orporate eal that as vuas Sii affixed by order of the Eoard of Di�ctors of:said corporation;,and that he/she
<br /> si tied his/her:>na�ne the;eto by Ji order,and tiie giant did:turtheri deppsa.and-:say that the Superintendent of
<br /> Insuranne of tho State a i ew Y.0 has, Pursuant#a SeGhan 1 111 of the Insurance Law of;the State of New
<br /> ARCH INSURANCE:CaMPANY
<br /> York,tssuec tQ..,,....f..•.....,:... . ..,.,.
<br /> qualification ev[�1Enctr► the quailfieation:of std:CAmPany.attd.its:sticienGy under. any law,of':the:State of
<br /> New Ycirk:as'sntety.`and guarantor; and::the propriety gf ameptin apps as such; and that such
<br /> certifcate has no); eeti revokad :.
<br /> GRACEAg4Ei??�?N ............... .... ......................... •..
<br /> teary pobq-S�tP of Neo YaYk a Pttblic
<br /> Nassau County
<br /> Ik:�01ACG111:5'](1
<br /> : Tertn:h3c�(Rs]urue 14,?016
<br /> NY acknowledgment::
<br />
|