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Form Exc-Cig-Bnd-01.01 - Surety Bond Posted To Secure Performance Under Title 32 - Nevada Department Of Taxation Page 2

AFFIDAVIT OF QUALIFICATION

(Must be completed by surety)

State of _________________

County of _______________

On the ______________day of ______________________________ in the year, _______ before me personally appeared

_________________________________________________, being first duly sworn on oath deposes and says that (s)he is the

_____________________________, of said insurance company, and that (s)he is duly authorized to execute and deliver the

foregoing obligation; that said insurance company is authorized to execute the same and has complied in all respects with the laws of

Nevada in reference to becoming sole surety upon bonds, undertaking and obligations

Notary Public

Residing at

My commission expires

[Seal]

CORPORATE ACKNOWLEDGMENT

State of __________________

County of ________________

On the _______ day of____________ in the year _________, before me personally appeared

______________________________ to me known who, being by me duly sworn, did depose and say: That (s)he resides in

_________________________________ that (s)he is the _______________________ of _____________________________

the corporation which executed the instrument on the reverse and which is described therein; that (s)he signed the instrument on

behalf of the said corporation; that (s)he was authorized to do so by Article ______________ of the Articles of Incorporation of the

said corporation, and by order of the Board of Directors of said corporation; and that his/her signature as it appears on the instrument

is binding upon the corporation.

Notary Public

Residing at

My commission expires

[Seal]

SOLE OWNER OR PARTNERSHIP ACKNOWLEDGMENT

State of ____________________

County of __________________

On the _______ day of____________ in the year _________, before me personally appeared

______________________________ to me known who, being by me duly sworn, did depose and say: That (s)he is

_________________ of _______________________, and that (s)he is duly authorized to execute on behalf of the said business

the instrument on the reverse and which is described therein.

Notary Public

Residing at

EXC-CIG-BND-01.01

My commission expires

[Seal]

Revised 7-10-96

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Form Exc-Cig-Bnd-01.01 - Surety Bond Posted To Secure Performance Under Title 32 - Nevada Department Of Taxation Page 2