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BID BOND (PENAL SUM FORM) <br />Bidder <br />Surety <br />Name: Selge Construction Co., Inc. <br />Name: The Cincinnati Insurance Company <br />Address {principal place of business): <br />Address (principal place of business): <br />2833 South 11th Street <br />P.O. Box 145496 <br />Niles, MI 49120 <br />Cincinnati, OH 45250-5496 <br />Owner <br />Bid <br />Name: City of South Bend Board of Public Works <br />Project (name and location): <br />Address (prindpol place of business): <br />2024 Lead Service Line Replacements - Southwest <br />227 West Jefferson Boulevard <br />Zone - Project No. 123-069B <br />South Bend, IN 46601 <br />Bid Due Date: May 14, 2024 <br />Bond <br />Penal Sum: 5% Five Percent of Amount Bid <br />Date of Bond: May 14, 2024 <br />Surety and Bidder, intending to be legally bound hereby, subject to the terms set forth in this Bid Bond, <br />do each cause this Bid Bond to be duly executed by an authorized officer, agent, or representative. <br />Bidder <br />Surety <br />Sel a Construction Co., Inc. <br />The Cincinnati Insurance Company <br />IF far al n e a idder <br />(Fuli far al name of Surety) (corporate seaKCOMR <br />By: <br />• <br />By: S E <br />(Signature) <br />(Signature) (Attach Power ofAttorn 11-1 <br />aao <br />Name: Justin Butler <br />Name: Tracie House <br />(Printed or typed) <br />(Printed or typed) <br />Title: ice President <br />Title: Attome -in-Fact <br />Attest:,_ � a, <br />Attest: '��41 <br />(Signature) <br />(Signature) <br />Name: Allison Swinehart <br />Name: Tracey Heiss <br />(Printed or typed) <br />(Printed or typed) <br />Title: Corp. Secretary <br />Title: Witness <br />Notes: (1) Note: Addresses are to be used for giving any required notice. (2) Provide execution by any additional parties, such as <br />joint venturers, if necessary. <br />LTE <br />L <br />EICDC® C-430, Bid Bond (Penal Sum Form). (EA-O2121) <br />Copyright° 2018 National Society of Professional Engineers, American Council of Engineering Companies, <br />and American Soclety of Civil Engineers. All rights reserved. <br />Page i of 2 <br />