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(Proprietorship or Partnership) <br />Attest: (Corporation) Title: _______________________________ <br /> (Owner, Partner, or Corp. Pres. or Vice <br />Pres. only) <br />By: _______________________________ <br />Title: ______________________________ <br />(Corp. Sec. or Asst. Sec. only) <br />(Corporate Seal) <br /> ___________________________________ <br /> (Surety Company) <br />Witness: By: ________________________________ <br />________________________________ Title: _______________________________ <br /> (Attorney in Fact) <br />Countersigned: <br />________________________________ (Surety Corporate Seal) <br />________________________________ <br />(N.C. Licensed Resident Agent) <br />________________________________ <br />________________________________ <br />Name and Address-Surety Agency <br />________________________________ <br />________________________________ <br />Surety Company Name and N.C. <br />Regional or Branch Office Address <br />Docusign Envelope ID: 44C13555-A1DE-83DE-8008-D9A38861DC35