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BID BOND (PENAL SUM FORM) <br />Bidder Surety <br />Name: Selge Construction Co., Inc. Name: The Cincinnati Insurance Company <br />Address (principal place of business): Address (principal place of business): <br />2833 South 11th Street P.O. Box 145496 <br />Niles, MI 49120 Cincinnati, OH 45250-5496 <br />Owner Bid <br />Name: City of South Bend Board of Public Works Project (name and location): <br />Address (principal place of business): 2024 Lead Service Line Replacements - West Zone - <br />227 West Jefferson Boulevard Project No. 123-069A <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 Surety <br />Sel a Construction Co., Inc. The Cincinnati Insurance Company <br />(Full fa al n me of idderJ [Full for al name of Surety) (corporate se cORPa <br />S E <br />By: By: <br />L <br />(Signature) (Signature)(Attach PowerofRttorn coo <br />Name: Justin Butler Name: Tracie House <br />(Printed or typed) (Printed or typed) <br />Title: Viqe President Title: Attorney -in -Fact <br />Attest: l l f t~1 � Attest: <br />(Signature) (Signature) <br />Name: Allison Swinehart Name: Tracey Heiss <br />(Printed or typed) (Printed or typed) <br />Title: Corp. Secretary 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 />EJCDC® C-430, Bid Bond (Penal Sum Form). (EA-02121) <br />Copyrights 2018 National Society of Professional Engineers, American Council of Engineering Companies, <br />and American Society of Civil Engineers. All rights reserved. <br />Page i of 2 <br />