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Executed this 21 day of� ��• <br />*Prior to signing, please ensure the name of the business has been filled in page one of the indemnity agreement. <br />An authorized representative (owner, president, managing member) must sign on behalf of the business. <br />Andemnitox iftthese : <br />Company Name: R iable Roofing and Construction <br />Authorized Signature: <br />E Printed Name: Abraham ordillo <br />mu owners ano ineir spuuses muse sign as mummuai muemmzurs. <br />Indeminitnr (Individual :, lnoemnitor (Spouse): <br />Signature: Signature: <br />Printed Name,Abraham Gordillo Printed Name: <br />Indemnitor (h <br />Signature: <br />Printed Name. <br />iyidual): <br />I Inde.mnitor (Spouse): <br />Signature: <br />Printed Name: <br />; <br />Wgn)nitor- (Individual): Indemnitor (Spouse): ----- <br />Signature: Signature: <br />Printed Name: Printed Name: <br />-!04ernnlitor (Individua": T — —Y - Indemnitor (Spouse): -- -- <br />Signature: ! Signature: <br />Printed Name: Printed Name: <br />I <br />Indemnitnr (individual): Indemn (Spouse): <br />Signature: Signature: <br />Printed Name: Printed Name: <br />Indemnitbr (individual): <br />Signature: <br />Printed Name: �- <br />Indemnitor (Spouse): <br />Signature: <br />Printed Name: <br />NB 0070 0125 Page 5 of 5 <br />1900 S 18th Avenue i West Bend, WI 53095 1 Phone: (800) 236-5010 1 Fax: (877) 674-2663 1 ww.thesilverlining.com <br />