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(Notarial Seal) <br />STATE OF MINNESOTA ) <br />COUNTY OF )SS <br />(Notarial Seal) <br />CERTIFICATE OF ACKNOWLEDGMENT BY PRINCIPAL <br />(For use where Contractor is Individual or Partnership) <br />On this day of , 2012, before me personally appeared <br />, to me known to be the person described in and <br />who executed the foregoing conditions, and acknowledged that he /she executed the same as <br />free act and deed. <br />CERTIFICATE OF ACKNOWLEDGMENT <br />(For use where Contractor is a Corporation) <br />STATE OF MINNESOTA <br />COUNTY OF )SS <br />Notary Public <br />On this day of , 2012, before me personally appeared and <br />to me personally know, who being by me duly sworn, did say that they are <br />respectively the that the seal affixed to the foregoing instrument is the corporate <br />seal of said corporation, and that said instrument was executed in behalf of the corporation by authority of its Board <br />of Directors, and said and acknowledged the <br />instrument to be the free act and deed of said corporation. <br />Notary Public <br />Full Name of Surety Company Home Office Address <br />Name of Attorney -in -Fact Name of Local Agency <br />Address of Local Agency Name of Agency Affixing Countersignature <br />Address <br />MEMORANDUM: Affix here Power of Attorney and Acknowledgment of Corporate Surety. <br />