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PENAL SUM FORM <br />Any singular reference to Bidder, Surety, Owner or other party shall be considered plural where applicable. <br />BIDDER (Name and Address): <br />Selge Construction Co., Inc. <br />2833 S. 1 lth Street <br />Niles, MI 49120 <br />SURETY (Name and Address of Principal Place of Business): <br />Merchants Bonding Company (Mutual) <br />A Corporation <br />6700 Westown Parkway, West Des Moines, IA 50266 <br />OWNER (Name and Address): <br />City of South Bend Department of Public Works <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />10 <br />Bid Due Date: March 10, 2020 <br />Description: CSO 003 Backwater Valve Replacement <br />BOND <br />Bond Number: <br />Date (Not earlier than Bid due date): March 10, 2020 <br />Penal sum Five Percent of Accompanying Bid $ (5%) <br />(Words) (Figures) <br />Surety and Bidder, intending to be legally bound hereby, subject to the terms set forth below, do each cause this Bid <br />Bond to be duly executed by an authorized officer, agent, or representative. <br />BIDDER <br />Selge Construction Co., Inc. <br />Bidder's Name and Corporate Seal <br />� <br />By <br />S'i°gnature <br />t.. <br />Justin Butler <br />Print Name <br />Director, Operations <br />Title" <br />Attest: <br />Signature <br />SecretgKy <br />Title <br />SURETY <br />(Seal) Merchants Bondin Com an (Mutual) (Seal) <br />Surety's Name and Corporate Sep � <br />Sl attire (Attach Power of Attorney) <br />Elaine K. Miller <br />Print Name <br />Attorney -in -Fact <br />Title <br />Attest: <br />Sig iature <br />Kay Borton, Claims Analyst <br />Title <br />Note; Above addresses are to be used for giving any required notice. Provide execution by any additional parties, <br />such as joint venturers, if necessary. <br />EJCDC C430 Bid Bond (Penal Sum Form) <br />Prepared by the Engineers Joint Contract Documents Committee. <br />Pa e 1 of 2 <br />2019.01884 <br />