JensenEl License Bond.tif01/20/2016 15:39 14022964412 FARM BUREAU PAGE 02/04
Effective Date: Januar 2pt�1 2016
Western Surety Company
LICENSE AND PERMIT BOND
KNOW ALL PERSONS 13Y THESE PRESENTS, Bond. No_ 62647611
That we, Justin Jensen
Of Plat 2nL1 sState of Nebraska as
and WESTERN SURETY COMPANY, a corporation duly licensed to do surety business in theStateof
Nebraska , as Surety, are held and firinly bound unto the
City Qe flair , State of xa , as Obligee, in tho penal
SUM of Five DOLLARS { WSJ 000.0o )
lawful money of the United States, to be paid to the Obligee, for which payment well and truly to be made,
we bind; ourselves and our legal representatives, firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been
licensed Electrical Contractor
by the Obligee,
NOW, THEREFORt, if the Principal shall faithfully perform the duties and in all things comply
with the.laws and ordinances, including all amendments thereto, pertaining to the license or permit
applied ; for, then this obligation to be void, otherwise to remain in fill force and effect until
January 20th 2017 , unless renewed by Continuation Certificate,
This bond may be terminated at any time by the Surety upon sending; notice in writing, by )First Class
U.S. Mail, to the Obligee and to the Principal at the address last .known to the Surety, and at the expiration
of thi .i"Iftays from the mailing of said notice, this bond shall ipso facto terminate and the Surety
sh tup eved from any liability for any acts or omissions of the principal subsequent to said
d ie number of years this. bond shall continue in force, the number of claims made
aj is bol Z44�the number of premiums which. shall be payable or paid, the Surety's total limit of
:shall not ;',rulative from year: to year or period to period, and in no event shall the Surety's total
Ci _t, to "exceed the amount set forth above, &-iy revision of the bond ainQunt shall not be
Forth 532-12-2015
20th day of. k'an.uary 2016 _,
Principal
Principal
WESTE SUREIP5 COMPANY
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Pau�)Bat' rooident
01/2012016 15:33 14022964412 FARM BUREAU PAGE 03104
ACKNOWLEDGMENT OF SURIr'1'iY
STATE (?F SOUT]:I DAKOTA ACKNOWLEDGMENT
Officer) O)F MINNE£IAHA ss
Ont his 20th day o£ Januar 2016_ before me, the imclersigned officer,
personally: appeared Paul T , Bruflat , w110 aeknowIedged himself to be the aforesaid
officer of. WESTERN STJRETY COMPANY, o corporation, and that he as such officer', being authorized so to do, executed
the fasegoing xmetrument for the Purposes therein contained, by signing the namo of the corporation by himself as such
officer, •
.IN WITNESS WHEREOF, I have hereunto set Amy hand awl official seal,
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AL NOTARY PU8LI080
a SOUTH 13AKOTA Notary Public — South Dakota
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COTJNTY OF
On" day of, before me Personally appeared
knows, t. me to be toe individual _ described in and who executed the foregoing instrument and acknowledged to me
that —lie — executed the same.
My cork ilission expires
Notary Public
AACKNOWLEDQM), ,NT OF PRINCIPAL
STATE 6F (Corporate Officer)
COUNT'' OF _ ss
On this day of , , before me personally appeared
who acknowledged himselflhexeeli'to be the
of , a corporation, awl that helshe as
such offiber being authorized so to do, executed the foregoing instrument for the purpoyo8 therein contained by sighing
the namo o£ the corporation by himselfllierself as such officer,
My cotz,iuissian expires
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01120/2016 15:33 14022964412 FARM BUREAU PAGE 04/04
Western Surety Company
PCW -R OF ATTORNEY
KNOW ALL MEN BYTHESE PRESENTS:
That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and
authorized 'and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut,
Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey,
New McXico; New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina,
South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United
States of America, does hereby make, constitute and appoint
Paul T. Bruflat of oux F�lle
State ofn,th Daknta its regularly elected
as Attorney -in -Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for and on
its behalf aA Surety and as its act and deed, the following bond:
One Electrical cvaxtractiox
bond with bond number 62¢47611
for tiiz s en
as principal in the penalty amount not to exceed:
Wasted Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws Of Western Surety Company
duly adopted and now in force, to -wit:
Section; 7. All bonds, policies, undertakings, Powers of Attorney, Or other obligations of the corporation 0ali be executed in the corporate
name of the;Cornpany by the President, Secretary, any Assistant Sooretwy, Treasurer, or any Vice President, or by such other officers as the
Board of Directors may authorize, The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint
Attorneys-ln ;Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company, The corporate seal Is
not necessary for the validity of any bonds, policies, undertaking$, Powers of Attorney or other obligatlotle of the corporation. The signature of any
such officer End the corporate seal may be printed by facsimile.
in Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its
en with the corporate seal affixed this 2 Qtsh _ day of January
2016 1
ATTEST
L. Nelson, A$ststant Secretary
STATE OF -SOUTH DAKOTA
COUNTY OF MINNI;HAHA ss
WESTE N U'jFtET COMPANY
By
Paul T fru@at, Vice President
On this _�2 pth °sema
,. day of ------ January 201 � ,before me, a Notary Public, personaltynally appeared
Paul T. Bruflat and z . Nclspzx
who, being;by me duly sworn, acknowledged that they slgned the above Power of Attorney as _ VAee President
and Assistant Secretary, respectively, of the acid WESTERN SURETY COMPANY, and acknowledged said instrument to be the
voluntary abt and deed of said Corporation.
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To vAlWa.te bond authenticity, go to WWW gAAn Xty_eQM 7 Owtler/Obligoo Servioe$ Validate Bond Covepage.
Form F1@76-1-2416