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DocuSign Envelope ID: 313DA256 -1EDE- 4396- A716- 4C53B809027E <br />Witness: <br />Contractor: (Trade or Corporate Name) <br />By: _ <br />(Proprietorship or Partnership) <br />Attest: (Corporation) Title: <br />(Owner, Partner, or Corp. Pres. or Vice Pres. only) <br />C <br />Title: <br />(Corp. Sec. or Asst. Sec.. only) <br />(Corporate Seal) <br />(Surety Company) <br />Witness: By: <br />Title: <br />(Attorney in Fact) <br />Countersigned: <br />(Surety Corporate Seal) <br />(N.C. Licensed Resident Agent) <br />Name and Address - Surety Agency <br />Surety Company Name and N.C. <br />Regional or Branch Office Address <br />