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FJCID C <br />UIGP' EE4� to.., CW,-iS(.I <br />.0UL 't", i C-l" <br />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 />Cornerstone Stewards, Inc. <br />5720 Huguenard Road <br />Fort Wayne, IN 46818 <br />SURETY (Name, and Address of Principal Place of Business): Western Surety Company: South Dakota Corporation <br />151 N. Franklin Street, 17th Floor <br />Chicago, IL 60606 <br />OWNER (Name and Address): <br />City of South Bend, Indiana <br />Department of Public Works <br />County -City Building Room 1316 <br />227 West Jefferson Street <br />South Bend, IN 46601 <br />BID <br />Bid Due Date: 12/ 12/2018 <br />Description: <br />WWTP Raw Sewage Pump No. 2 Rehabilitation (31 l3 Riverside Drive, South Bend, Indiana 46628) <br />BOND <br />Bond Number: <br />natP. December 12, 2018 <br />Penal sum Five Percent of Accompan in 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 <br />this Bid Bond to be duly executed by an authorized officer, agent, or representative, <br />BIDDER SURETY <br />Cornerstone Stewards, Inc, (Seal) Western Surety Company (Seal) <br />Bidder's Name apl, Corporate Seal Surety's Name and Corporate Seal <br />1 � 4 ) a u <br />By: <br />Signature Signature (Attach Power of Attorney) <br />MCL5 0 Laura L. Divemrm <br />Print Name Print Name <br />Attorney -in -Fact <br />Title Tit(e <br />Attesta I�M Attest: <br />" <br />Signature Signatur da Karst <br />Title �� , Title <br />a t- �C.1.e.�tit..�. ��.... � � CSA <br />Note; Addresses are to be used for giving any rLyquired notice. Provide execution by any additional parties, such <br />as joint venturers, if necessary, <br />EJCDC® C-430, Bid Bond (Penal Sum Form). Published 2013, <br />Prepared by the Engineers Joint Contract Documents Committee, <br />Page 00 43 13-1 of 2 <br />