+--------------------+--------------------+--------------------+---+
| **AFFIDAVIT OF     |                    |                    |   |
| INDIVIDUAL         |                    |                    |   |
| SURETY**           |                    |                    |   |
|                    |                    |                    |   |
| ***(See            |                    |                    |   |
| instructions on    |                    |                    |   |
| reverse)***        |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| STATE OF           |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| COUNTY OF          | **SS.**            |                    |   |
+--------------------+--------------------+--------------------+---+
| I, the             |                    |                    |   |
| undersigned, being |                    |                    |   |
| duty sworn, depose |                    |                    |   |
| and say that I am: |                    |                    |   |
| (1) the surety to  |                    |                    |   |
| the attached       |                    |                    |   |
| bonds, (2) a       |                    |                    |   |
| citizen of the     |                    |                    |   |
| United States; and |                    |                    |   |
| of full age and    |                    |                    |   |
| legally competent. |                    |                    |   |
| I also depose and  |                    |                    |   |
| say that,          |                    |                    |   |
| concerning any     |                    |                    |   |
| stocks or bonds    |                    |                    |   |
| included in the    |                    |                    |   |
| assets listed      |                    |                    |   |
| below, that there  |                    |                    |   |
| are no             |                    |                    |   |
| restrictions on    |                    |                    |   |
| the resale of      |                    |                    |   |
| these securities   |                    |                    |   |
| pursuant to the    |                    |                    |   |
| registration       |                    |                    |   |
| provisions of      |                    |                    |   |
| Section 5 of the   |                    |                    |   |
| Securities Act of  |                    |                    |   |
| 1933. I recognize  |                    |                    |   |
| that statements    |                    |                    |   |
| contained herein   |                    |                    |   |
| concern a matter   |                    |                    |   |
| within the         |                    |                    |   |
| jurisdiction of an |                    |                    |   |
| agency of the      |                    |                    |   |
| United States and  |                    |                    |   |
| the making of a    |                    |                    |   |
| false, fictitious  |                    |                    |   |
| or fraudulent      |                    |                    |   |
| statement may      |                    |                    |   |
| render the maker   |                    |                    |   |
| subject to         |                    |                    |   |
| prosecution under  |                    |                    |   |
| Title 18, United   |                    |                    |   |
| States Code        |                    |                    |   |
| Sections 1001 and  |                    |                    |   |
| 494. This          |                    |                    |   |
| affidavit is made  |                    |                    |   |
| to induce the      |                    |                    |   |
| United States of   |                    |                    |   |
| America to accept  |                    |                    |   |
| me as surety on    |                    |                    |   |
| the attached bond. |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| 1\. NAME (First,   | 2\. HOME ADDRESS   |                    |   |
| Middle, Last)      | (Number, Street,   |                    |   |
| (Type or Print)    | City, State, Zip   |                    |   |
|                    | Code)              |                    |   |
+--------------------+--------------------+--------------------+---+
| 3\. TYPE AND       | 4\. NAME AND       |                    |   |
| DURATION OF        | ADDRESS OF         |                    |   |
| OCCUPATION         | EMPLOYER (if       |                    |   |
|                    | Self-employed, so  |                    |   |
|                    | state)             |                    |   |
+--------------------+--------------------+--------------------+---+
| 5\. NAME AND       | 6\. TELEPHONE      |                    |   |
| ADDRESS OF         | NUMBER             |                    |   |
| INDIVIDUAL SURETY  |                    |                    |   |
| BROKER USED (if    | HOME\--            |                    |   |
| any)               |                    |                    |   |
|                    | BUSINESS\--        |                    |   |
+--------------------+--------------------+--------------------+---+
| 7\. THE FOLLOWING  |                    |                    |   |
| IS A TRUE          |                    |                    |   |
| REPRESENTATION OF  |                    |                    |   |
| THE ASSETS I HAVE  |                    |                    |   |
| PLEDGED TO THE     |                    |                    |   |
| UNITED STATES IN   |                    |                    |   |
| SUPPORT OF THE     |                    |                    |   |
| ATTACHED BOND.     |                    |                    |   |
|                    |                    |                    |   |
| \(a\) Real estate  |                    |                    |   |
| include a legal    |                    |                    |   |
| description,       |                    |                    |   |
| street address and |                    |                    |   |
| other identifying  |                    |                    |   |
| description; the   |                    |                    |   |
| market value;      |                    |                    |   |
| attach supporting  |                    |                    |   |
| certified          |                    |                    |   |
| documents          |                    |                    |   |
| including recorded |                    |                    |   |
| lien; evidence of  |                    |                    |   |
| title and the      |                    |                    |   |
| current tax        |                    |                    |   |
| assessment on the  |                    |                    |   |
| property. For      |                    |                    |   |
| market value       |                    |                    |   |
| approach, also     |                    |                    |   |
| provide a current  |                    |                    |   |
| appraisal.         |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| \(b\) Assets other |                    |                    |   |
| than real estate   |                    |                    |   |
| (describe the      |                    |                    |   |
| assets, the        |                    |                    |   |
| details of the     |                    |                    |   |
| escrow account,    |                    |                    |   |
| and attach         |                    |                    |   |
| certified evidence |                    |                    |   |
| thereof            |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| 8\. IDENTIFY ALL   |                    |                    |   |
| MORTGAGES, LIENS,  |                    |                    |   |
| JUDGMENTS, OR ANY  |                    |                    |   |
| OTHER ENCUMBRANCES |                    |                    |   |
| INVOLVING SUBJECT  |                    |                    |   |
| ASSETS INCLUDING   |                    |                    |   |
| REAL ESTATE TAXES  |                    |                    |   |
| DUE AND PAYABLE.   |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| 9\. IDENTIFY ALL   |                    |                    |   |
| BONDS, INCLUDING   |                    |                    |   |
| BID GUARANTEES,    |                    |                    |   |
| FOR WHICH THE      |                    |                    |   |
| SUBJECT ASSETS     |                    |                    |   |
| HAVE BEEN PLEDGED  |                    |                    |   |
| WITHIN 3 YEARS     |                    |                    |   |
| PRIOR TO THE DATE  |                    |                    |   |
| OF EXECUTION OF    |                    |                    |   |
| THIS AFFIDAVIT     |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| **DOCUMENTATION OF |                    |                    |   |
| THE PLEDGED ASSET  |                    |                    |   |
| MUST BE ATTACHED** |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| 10\. SIGNATURE     | 11\. BOND AND      |                    |   |
|                    | CONTRACT TO WHICH  |                    |   |
|                    | THIS AFFIDAVIT     |                    |   |
|                    | RELATES (Where     |                    |   |
|                    | appropriate)       |                    |   |
+--------------------+--------------------+--------------------+---+
| 12\. SUBSCRIBED    |                    |                    |   |
| AND SWORN TO       |                    |                    |   |
| BEFORE ME AS       |                    |                    |   |
| FOLLOWS;           |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| a\. DATE OATH      | b\. CITY AND STATE | Official Seal      |   |
| ADMINISTERED       | (Or other          |                    |   |
|                    | jurisdiction)      |                    |   |
| MONTH DAY YEAR     |                    |                    |   |
+--------------------+--------------------+--------------------+---+
| c\. NAME AND TITLE | d\. SIGNATURE      | e\. MY COMMISSION  |   |
| OF OFFICIAL        |                    | EXPIRES            |   |
| ADMINISTERING OATH |                    |                    |   |
| (Type of print)    |                    |                    |   |
+--------------------+--------------------+--------------------+---+

**INSTRUCTIONS**

1\. Individual sureties on bonds executed in connection with Government
contracts, shall complete and submit this form with the bond. (See 48
CFR 28.203, 53.22B(e) ). The surety shall have the completed form
notarized.

2\. No corporation, partnership, or other unincorporated associations or
firms, as such, are acceptable as individual sureties. Likewise menders
of a partnership are not acceptable as sureties on bonds which
partnership or associations, or any co-partner or mender thereof is the
principal obligor. However, stockholders of corporate principals are
acceptable provided (a) their qualifications are independent of their
stockholdings or financial interest therein, and (b) that the fact is
expressed in the affidavit of justification. An individual surety will
not include any financial interest in assets connected with the
principal on the bond which this affidavit supports.

3\. United States citizenship is a requirement for individual sureties.
However, only a permanent resident of the place of execution of the
contract and bond is required for individual sureties in the following
locations - any foreign country; the Commonwealth of Puerto Rico; the
Virgin Islands; the Canal Zone; Guam; or any other territory or
possession of the United States.

4\. All signatures on the affidavit submitted must be originals.
Affidavits bearing reproduced signatures are not acceptable. An
authorized person shall sign the bond. Any person signing in a
representative capacity (e.g. an attorney-in-fact) must furnish evidence
of authority if that representative is not a member of a firm,
partnership, or joint venture, or an officer of the corporation
involved.