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Home My WebLink AboutR-90-07672 i, { 10/9/90 r 9U- '76 RESOLUTION NO. A RESOLUTION AUTHORIZING THE PAYMENT OF A CERTAIN CITY- OF MIAMI, FLORIDASTORM SEWER IMPROVEMENT BOND COUPON, IN THE AMOUNT OF ONE HUNDRED AND SIXTY DOLLARS ($160.00) DESPITE THE ABSENCE OF AN ORIGINAL COUPON. BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI, FLORIDA! Section 1. The Commission of the City of Miami, Florida (the "City Commission") hereby finds and determined that: (a) The City Commission has received and caused to be examined an affidavit sworn and subscribed to before a notary public on January 14, 1990, by the American Savings & Loan Association of Florida, that (i) The American Savings & Loan Association of Florida held one Coupon, No. 29 at $160.00, due September 6, 1989, detached from Bond No.:506 of City of Miami, Florida Police Storm Sewer Improvement Bond dated March 1, 1975, due March 1, 1.992, 6.40%, principal amount Five Thousand.Dollars ($5,000.00), at its. premises located; at 17801 Northwest 2nd Avenue, Miami, Florida 33169, on or about December 8, 1989; (ii) r a thorough search has been conducted and the said Coupon cannot be: found; (iii) except as specifically stated, neither said Coupon nor any interest therein- has been knowingly sold; assigned, endorsed;; transferred, deposited under any agreement, hypothecated, -pawned,' pledged for any bank or brokerage loan=or, otherwise, or disposed of in any manner by, or on behalf of said American,Savings & Loan Association. Records indicate that the Coupons were lost by the American Savings & Loan Association courier. The Bank has no actual knowledge of disposition of these Coupons in any manner by any person; (iv) the affidavit is made and a Bond of Indemnity will be given for the purpose of inducing the issuance of payment in lieu of and in substitution CIT �A A!J V Z l �r } t5 F x , . or in ekchango fdr said loat, stolen or destroyed Coupon without requiring the surrender of the original or the payment, del.iveryt exchange or credit in respect to such original without... such durt4hdar; (v) if the American Savings & Loan Association"should knowlnij .y find or recover the original Coupon, it will inl�nediatoly surrender the same to the paying agent without requiring any consideration therefor. (b) The City Commission has received and caused to be examined a Counterpart of Indemnity Bond, Bond No. 4575595420-589, (hereinafter called the "Indemnity Bond"), executed July 10, 1990 by the Federal Insurance Company, pursuant to which the Federal Insurance Company is firmly bound unto the City of Miami, Chase Manhattan Bank, and any other parties vested with powers or duties respecting the original Coupon (herein an in the Indemnity Bond called the "Obligee") in an aggregate amount sufficient to indemnify the Obligee in connection with the _ payment of the Coupon, the Federal Insurance Company will be responsible for such litigation on behalf of the Obligee, and in any event will pay all costs and counsel's fee connected with such litigation, and will indemnify the Obligee as otherwise provided in the Indemnity Bond. Section 2. The Chase Manhattan Bank, in the Borough of Manhattan, City and State of New York, is authorized and directed _ herewith to pay Coupon No. 29 in the amount of One Hundred Sixty Dollars ($160.00), due September 1, 1989 from Bond No. 506 of the City of Miami, Florida Storm Sewer Improvement Bonds respectively, Section 3. This Resolution shall become effective immediately upon its adoption. Y et ! O a I =. PASSED AND ADOPTED this 18th day of October _.r 1990 r PREPARED AND APPROVED M. I_r.. aitV it RA AEL_O.'DIAZ Chief Assistant City A torney APPROVED -AS TO FORM AND CORRECTNESS: E L 0 GE ._:. F. RNANDEZ City Attorney s ry ROD/pb/M1775 „ t 7 7 t , -?:t 4 k f_ Y ergy" e �3 r t t, t t f THE CHAISE MANHATTAN BANK, N. A ONE NEW YORK PLAZA-14TH PLO NEW YORK, NEW YQRX 10001 4630/MP-1/2419037 08/31/1990 ATT: CITY OF MIAMI FLORIDA P.O. BOX 33:133 MIAMI, FLORIDA 33133` DIRECTOR OF FINANCE'' RE: 2 CPNS DUE 9/1/89 @ 160.00 CITY 'OF MIAMI _ 6.40% STORM SEWER IMPROVEMENT BOND* DTY 3/1/75 DUE 3/1/92 BOND # 606/07 P/A $ 5, 000.00 WE ENCLOSE FOR YOUR FILES, DOCUMENTS SUBMITTED TO US TO SUPPORT REPLACEMENT OF THE ABOVE DESCRIBED SECURITIES PER- VIOUSLY REPORTED LOST, STOLEN OR DESTROYEDS. THESE DOCUMENTS ARE SATISFACTORY TORUS. IF THEY MEET WITH YOUR APPROVAL, WE.REQUEST THAT -YOU FURNISH US WITH ''A'LETTER AUTHORIZING US TO REPLACE THE SUBJECT SECURITIES. IT IS IMPERATIVE THAT WE RECEIVED A REPLY WITHIN ONE MONTH. FROM THE DATE OF 'RECEIPT OF THIS REQUEST. Y WE WOULD'APPRECITATE-YOUR COOPERATION IN'THIS`MATTER.' •IF:WE"CAN `BE OF FURTHER ASSISTANCE' PLEASE `CONTACT US AT 1_(21&` 676-5439. 3 S; RESPECTFULLY YOURS,' FRANK MEEHAN MUNICIPAL CUATOMER SERVICE CC: WARREN R. THOMPSON 17801 NORTHWEST SECOND AVE - MIAMI, FLORIDA 33169t" d cis }YC 4 9 6 ipg e turaF sy$��iSSi iit .1}5 xarr + '•c ��'.��`'"i'�-v� -- CHUBBAQROUP OF IN n UAN COMPANIES FEDERAL INSURANCE COMPANY BOND NO. 45758 a 95420-589 BOND OF INDEMNITY (OPEN PENALTY) KNOW ALL MEN BY VESE PRESENTS, that FEDERAL INSURANCE COMPANY N a corporation duly organized and•existing under and by virtue of the laws of the State of Indiana and duly - authorized to transact the business of Insurance in the State of New York and all other States in the United States of America and having an office and place of business in New York State at 100 William Street, New York, N.Y. 10038, as Obligor (hereinafter called the "Obligor" is held and firmly bound.,unto CITY OF MIAMI, FLORIDA THE CHASE MANHATFAN BANK, N.A. individually and/or as Trustee, Depositary, Fiscal, Paying or Disbursing Agent, Registrar, Transfer Agent, (and unto any other Trustees, Depositaries, Fiscal,,Paying or Disbursing Agents or Agencies, Registrars and/or Transfer Agents), their respective legal representatives, successors and assigns (hereinafter collectively called "Obligees"), in an aggregate sum, lawful money of the United States of America, sufficient to indemnify the Obligees under the conditions of this bond as hereinafter set forth, but not exceeding , the maximum amount for which Obligor may.obligate itself on the date of this bond in respect of any one risk or hazard under any law governing the validity or performance of this bond, said sum to be paid to Obligees, their respective, legal representatives,; successors or assigns, as interest may appear; for which payment well and truly. to be made'the Obligor binds itself, its legal representatives, successors and assigns, jointly and severally, firmly by these_ u presents. SEALED with its seal and executed in FOUR counterparts the 10th day of, July, 1990. WHEREAS, the Obligor represents that AMERICAN SAVINGS & LOAN ASSOCIATION OF FLORIDA is are the un / qualified owner(s) of 2 _ , _COUPONS-..; NO. 29 @,$160.00 EACH (TOTAL $280.00),DUE 9/1/89 DETACHED FROM CITY, OF MIAMI, FLORIDA, 6.40$ STORM SEWER IMPROVEMENT BOND, DTp,3/1/:75 DUE 3/1/921-BOND NUMBERS 506 & 507 P/A $5,600.00 (such security or ` securities being hereinafter called "original,, or "ori finals" g 9 ) , , .and that the same has/have been mislaid,:.lost, destroyed, or wrongfully. taken and cannot be found or produced, by virtue of 'which the Obligor has requested Obligees to issue and delver'to AMERICAN SAVINGS'& LOAN ASSOCIATION OF FLORIDA or his/her/its order a new or duplicate instrument'or instruments (hereinafter sometimes called "duplicate" or "duplicates"), or to pay to AMERICAN SAVINGS & LOAN ASSOCIATION OF r` FLORIDA or credit to his/her/its account the amount due on said original or originals without surrender'or presentation thereof for cancellation or stamping or for any other purpose/ and x � Y Yx t a a Z3 06 - ♦ - ;. _ f -f Zak#�r. �ti Ez / Enft\ :z HUBS MOUP OF NSURAN0#00MPANIES F909RAL INSURANCE COMPANY i BOND NO. 45755 95420-589 BOND OF INDEMNITY, (OVEN PENALTY) KNOW ALL MEN BY THESE PRESENTS, that FEDERAL INSURANCE COMPANY a corporation duly organized and'existing under and by virtue of the laws of the State of Indiana and duly authorized to transact the business of Insurance in the State of New York and all other States in the United States of America and having an office and place of business in New York State at 100 William Street, New York, N.Y. 10038, as Obligor (hereinafter called the "Obligor" is held and firmly bound.,unto CITY OF MIAMI, FLORIDA THE CHASE MANHATrAN BANK, N.A. individually and/or as Trustee, Depositary, Fiscal, Paying or Disbursing Agent, Registrar, Transfer Agent, (and unto any other Trustees, Depositaries, Fiscal, Paying or Disbursing Agents or Agencies, Registrars and/or Transfer Agents), their respective legal representatives, successors and assigns (hereinafter collectively_ called "Obligees"), in an aggregate sum, lawful money of the United States of America, sufficient to indemnify the Obligees under the conditions of this bond as hereinafter set forth, but not exceeding the maximum amount for which Obligor may.obligate itself on the date of this bond in respect of any one risk or hazard under any law governing the validity or performance of this bond, said sum to be paid to Obligees, their respective legal representatives, successors or assigns, as interest may appear; for which payment well and truly. to be made'the Obligor binds itself, its legal representatives,; successors.and assigns, jointly and severally, firmly by these presents. SEALED with its seal and executed in FOUR counterparts the loth day of July, 1990. WHEREAS, the Obligor represents. that AMERICAN SAVINGS & LOAN. ASSOCIATION OF FLORIDA.is/are the unqualified owners) of 2 COUPONS NO. 29 @,$160.00 EACH (TOTAL $280.00) DUE 9/l/89 DETACHED FROM CITY.O MIAMI, FLORIDA, 6.40% STORM SEWER IMPROVEMENT BOND, DTD 3/1/75.DUE 3/l/92, BOND NUMBERS 506`& 507 P/A $5,000.00 (such security.,or securities being hereinafter called "original$' or "originals"),,and. that the same has/have been mislaid,- .lost, destroyed, or wrongfully taken and cannot be found.or produced, by virtue of which the Obligor has requested Obligees to issue and deliver to AMERICAN SAVINGS'& LOAN., ASSOCIATION OF FLORIDA or his/her/its order a new or duplicate instrument or instruments (hereinafter sometimes called "duplicate" or ''duplicates'l), or to pay to A14ERICAN SAVINGS & LOAN ASSOCIATION OF FLORIDA or credit to his/her/its account the amount due on said original or originals without surrender'or presentation thereof for cancellation or stamping or for any other purpose; and 4f f-. M 1 } *ROWAN ems.. �p WHEREAS, on the faith of the foregoing representations and in consideration of this bond of indemnity, Obligees have complied or have agreed to comply with said requests. NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION ARE, that if the Obligor, the legal representatives, successors or assigns of the Obligor or any of them, shall in case the original or originals be found or come into the hands, custody or power of any of them, or into the hands, custody or power of any person, deliver or cause the same to be delivered unto Obligees in order to be cancelled, and shall also at all times defend, indemnify and save harmless o bligees from and against any and all claims, actions and suits, whether groundless or otherwise, and from and against any and all liabilities, losses, damages' costs, charges, counsel fees and other expenses of every nature and chatracter by reason of the original or . originals and/or the issuance of a duplicate or duplicates in lieu thereof or in lieu of any instrument or instruments of purported like issue and amount which because of alteration, change or counterfeit may or may not be identified as the said mislaid, lost stolen or destroyed original or originals, or 'the making of any payment, credit, transfer, registration, conversion, exchange, or delivery in respect of the original or originals without surrender thereof and/or in respect of the duplicate or duplicates, whether or not caused by based upon or arising out of the honoring or refusing to honor the original or originals when presented•by anyone, and/or whether or not caused by, based upon, or arising out of inadvertence, accident, oversight or neglect on the part df Obligees, or any of them, or their respective officers, agents, clerks or employees and/or omission or failure to inquire into, contest or litigate the right of any applicant to receive any payment., credit, transfer, registration, conversion, exchange, issue or delivery in respect of the original or originals and/or the duplicate or duplicates issued in lieu thereof, and/or caused by, based upon or arising out of the release of any security or the satisfaction of any instrument or instruments, under which the original or originals and/or duplicate or duplicates are issued or secured, and/or caused by, based upon or arising out of any other matter or thing whatsoever, then this Obligation shall be void; otherwise shall remain in full force and effect. Obligor further agrees that if the mislaid, lost, stolen, or destroyed original or originals be found or come into the hands, custody or power of any person or into the hands, custody or power of the Obligees or any of them for any purpose other than cancellation without reissue, the Obligor will forthwith on demand obtain and deliver to the Obligees either such original or originals or such duplicate or duplicates or will pay to the Obligees a sum of money sufficient to enable the Obligees to purchase in the open market securities of the same issue and amount as the original or originals. Obligor further agrees that, in case of any default under the conditions of this bond, the Obligor waives and releases any and,all right or claim against Obligees, or any of them whether by way of subrogation or otherwise, for any loss, expense or liability incurred by the Obligor caused by, based upon or arising out of the enforcement of this bond by the Obligees or any of them. (No inaccuracy in the description of the securities herein referred to as original.or originals shall alter, modify or affect the obligations of the Obligor hereunder.) Obligor. agrees that its liability hereunder shall be absolute, subject only to the conditions herein expressed. FEDERAL INSURANCE COMPANY •. Yrr�Yy�eb ♦•�F1�M a 4 POWER of AAANY Y + KA Aif Men by area! Presents, that t' 01MAL IN6URANCII COMPAt? WAS lowntain.lr , t11IIs19�itt; Ni>tfih► Jersey, ah fnf�idhA f°�,btptftAtioh+ f ri Mark A..' frank, Chrif3 pher ..�rankiiir., I!i�Cs► { fiat bbnttltq*d and AWInt6d -and dose hereby 061 tuts end a0�rl t $urce>ti, Dorothy it+�rn, Maria Hughas t Gair. Vietar, •.Nan+cy Villa�tts and tibia Sant+iaga of ftv V6rk, y orrgY9Ycy Kor�Yiic� MarrW�rrrrriirr.�ar.... WriWir�iYra rcrrawi►.rcr lYrwcwoacrr�rirY�rrrarwwaYf xrsrcr�yrirarwWr lr�rwcrirwr,YYrrWaaili3r Yl �iilirnt f Ae ► i ` fl $ r �aWlUl Attorney-llr•FAct to sxeBUte under such deli nation In Its name and to affix Its Corporate goal to and deliver lot and Ph It:r behalf ariy �irid i till Wit lhi ttutwt Bonds whOrsin the said PtOERAL INSURANCI COMPANY Is naffed As Obligor. r (fifltAM wM#W. Ute flitd 01AL MURANCIt eOMHANY hft fwteushl to fb By -LAWS. awe, causild thew prasefts to be sailed tW fbl Vke f5rtideM and Aaaisunt saerwaty VA its txrpdtNe fiet0 to be hartllo "adtw ltat day of May fg 90 C r � � 1AN� ft;2UAANCII CMPAlW ey High b. blzbrl AsslatMlt GO M " Visa ItreWdei+! ` TAU OF NEW V011R ounty of New York ( - On this 18 t day of May 19 90 baton me personally came Richard HqM. to mA It. owl and by Mo known to ba Attennt Secretary of tta FEDERAL INSUPI OMPANY, the Cotporatmn otcnbad In and which executed the ton going It wW of Anorney and the said Richard Hight being by me duly swolf, , did depose and say that he to Assistant Saerotary Of the FED ERIU iaURANCE COMMNY and knows the Corporate seal thereof: That the sal alliited to 1M foragWng Power of kWhey is such Corporate seal and was ►Remo Affixed by authority of the ByLkft Of Said Cbnioafiy id that he signed said Power of Ahornsy as Aatstant Seemwy of said Company by like authority: that he is equainted with James D. Dixon and knows him to be Via Prssident of said Company, and onto the �fatum of said James D. Diiupn subae"bad to said Power of Attorney is in the genuine hatidwrning of said James 0. Olson and was tharelo subscribed by authordy of said Bylaws and in deponent'a presence M cQ� a Acknorriecged and Sworn to afore me on the date aWW wMten NOTARY t , tNf Pul!<,�C 'I Q. Mary E. M gt Nola bile A Notary W. State of New York No. OtMCa839 �� NE`N Ousldisd in Gueens County — Cefdicate find In ""S County Commission comes June 3a 1990 Financial Statement of Federal Insurance Company as of December 31, 1989 IN THOUSANDS OF DOLLARS - STATUTORY BASIS LIABILITIES AND ASSETS SURPLUS TO POLICYHOLDERS j United States Treasury Bonds .......... S 369,271 Outstanding Losses and Loss Expenses.. $ 2,668.438 I I United States Government and Federal Unearned Premiums 833.581 �IJ Agency Guaranteed Bonds........... 322.548 Accrued Expenses .... _ ........... 74,351 State and Municipal Bonds ...... .... 1,876.348 Non -Admitted Reinsurance. 42.658 i Other Bonds ... .. 451.764 Dividends to Policyholders . 23.840 ' Common Stocks ..................... 268,469 Lass Portfolio Transfer ................ (tat,624)' I Preferred Stocks . .................. 240 Other Liabilities . 180,214 Other Investted Assets ............... 57.838 Short Term Investments ............... 33,333 ' Real Estate 5.429 TOTAL INVESTMENTS .............. 3.385.228 TOTAL LIABILITIES ............ 3.681.456 Investments in Affiliates: Capital Stock ....... .. ........ 13.987 Vigilant Insurance Company.. ....... 173,621 Great Northern Insurance Company 55,990 Pali -in Surplus . 472.986 Pacific Indemnity Company ..... .. • 288.784 Bellemead Development Corporation... 336.518 Unassigned Funds ................... 457,187 C.C. Canada Holdings Lid ........... 62,616 } V Other . .................. . ... 46,140 Unrealised Appreciation of Investments .. 348.40 s Cash .............................. 13,121 , Net Premiums Receivable ............. 428,605 SURPLUS TO POLICYHOLDERS .... 1.292,623 i Reinsurance Recoverable on Paid Losses ........................... 45.982� Other Assets ...... .. .......... 137.576 TOTAL LIABILITIES AND SURPLUS TOTAL ADMITTED ASSETS .......... S a,97a,081 TO POLICYHOLDERS.... S 4.974.081 Investments are valued in accordance with requirements of the National Association of insurance Commissioners. Investments valued at $014 are deposited with government authorities as required by law. r 4, t•^ !fit •74t ,�P� Y { wt t r - - i J � �.✓ � rt c i ?,��t t i na .' _ .i� •i � PROOF OF LASS TO Ft- DERAG INSURANCE COMPANY + Al rIDAVIT OF MAILING AND TITLE Please note: Phis st►tora statement is intended for use in eonaection toith the reported nott•delivrr y, by floe U, S. Post Offlee I)epartitte►tt of a proprrl�� tttailed letter (not registered) cnnloininn .tcrtrritics at described 6elotr, Please be eertain that the addressee wha has retorted the ttott•detivery understands that the securities tvere going by dedhoory Pest -class utail and furnish the addressee with a sarttple of the covelope turd, DETAILS OF SHIPMENT (To be fully completed by the assured) +7r t; c •`':� •' SI.• �"it ,t4 d t tile. Mailed b (Sender) : American -'Savings &)roan Association of Florida Date: y September 6► 1989 o, ery Exact Namc and Address on Shipment: Manufacturers HariOver - Trust Co. 40 Wall Street New York, N.Y. 10268 CCem r, e_i, t sire,. cost Office at which mailed: N/A ( Airborne Express) CONTENTS: — Certificate No.: P Coupons'from various Securities per attached schedule-. i! Corporation: € Ciass of Stock: 1 Shares: Registered in name of N/A ( Bearer Bonds) Endorsements (If any)American Savings & Loan Assoc. of Florida + Collection Dept. (, The above contents are hereinafter called the "securities" STATE OF Florida t SS: COUNTY OF Dade Warren Thompson.. for -Amercan, Savin , , , , , .. I? , . , . , .. ...... 9 l�crcinafto called Deponent), being duly sworn. deposes and says:— .... That he is an officer of or partner in (to wit, the firm or corporation of having an office at . Your dsponcnt certifies that in accordanec with five records and regular procedure of the said firm or corporation, and pur- scant to live provisions of the insurance policy carried by it with the above mentioned company, the above described securities were forwarded by first class mail on the date specified to the above ranted addressee. The said addressee has reported the non -delivery of the said letter and the inability to find or locate the securities contained therein. Neither the said letter nor the. said securities have been returned to the sender and they are believed to have been lost or destroyed in transit in the mail. Iicpnncnt agrees on behalf of said firm or corporation that if the securities should ever come into their hands, custod or power, deponent will immediately surrender file original securities to the insurance Company. The said . •curitics: were the absolute, t sole arsd uncnctnnbcred property of said firm or corporation alcove mined and were insured in transi. for account of whom it stay concernuader twlicy of insurance issued by the said Insurance Company to dcponent's firm or corporation. Depnncnt knows that this affidavit will be used in support of the application to the issuing corporation its transfer j agents and registrars for the issuance under indemnity of new securities to replace the at or d strayed. f .. aponent' ` STATE or, Florida SS: COUNTY OF Dade On this 14th day of January 1990 before sue personally appeared th abovo deponent Warren R. rlhtampson to me known and known to silt: to Its: theist Iyfduat described in and who executed the foregoing agreement on behalf of the firm or corporation mentioned therein, and duly acknowl edged to me that he executed the same, and having boost duly swor aid that the statements therein were true. I�otttO► �'abttt; Qt 9*10c t of t»4 40 • • ta,Nr� �pFFiCt!!�. VTARV $W_ ANX Pelt 1. G STAB �. � r xt 'Form pQ=tA•�4kt 1Esl.g t341 tF�p►ttNrfy +{2#Fl 1 I /(, Nlt Ct�M1i',SSION UP,,, ��: d 0 a _ i Own It ) ; !t f ;t PROOF OF LOSS f To FEDERAL, INSURANCE COMPANY - AFFIDAVIT OF NON RECI PT please Note: This sworn statement is intended for use in connection with the reported non -delivery by the U.S. post office Depart• { mint, of a property mailed letter (NOT registered) Containing! securities as described below. please make another thorough search of your office, and make inquiries of the postman as welt as others who may have received the Mail in your absence. DVAIIS OF SHIPMENT (To be fully completed by Sender before forwarding this form to Addressee) We certify that this Is a true il< copy of the Original affidavit hold in Mailed by (Sender): American Savings & toan Association of Florida r tile. Date: September 6, 1989 N Exact Address on Shipment: MmUfacttlrers HattaVer Trust CdnPanV 40 Wall Street �� a New York, New York 10268 Post Office at which mailed: N/A (Airborne Express) CONTENTS:_ 44 Certificate No.: ( pC�lt13 from various securities �?u�tr,iad iA 9ron� ,;�v�ty C*"1rlCa1e Filed in New niy Corporation: Cemniission Expires Cau York Class of Stock: •� lenuery 31, 1992 Shares: Registered in name of: N/A (Bearer Bonds) i' Endorsements (If any) Am XiCan SaVings & roan Association of Florida } Collection Dept. The above contents are hereinafter called the securities �y STATE OF. SS: COUNTY OF (hereinafter called Deponent) being duly sworn, deposes and says:- i - 1. Thatshe is employed as 4Ss'istant manager by the addressee of the shipment above described, and nazi supervision of incoming first class mail so addressed. 2. That deponent certifies that according to the records of the said addressee, and to the best of deponent's knowledge. in- formation and belief, neither the above described shipment nor the securities mentioned above have ever been received by the addressee or by'anyone 'authorized by such addressee. Deponent has made a thorough search, and has made inquiries, but has found.no trace of the securities or the letter. 3. Oeponent agrees on behalf of the addressee that if the securities should ever come into their hands, custody or power, deponent will immediately notify the Sender, and will surrender the original securities to the Insurance Company above named, or, ! (it replacement securities have been issued) to the Issuing Corporation or its Transfer Agents. 4. Deponent knows_ that this affidavit will be used in support of application to the issuing .corporation and .its transfer agents ! i and registrars: for the issuance under indemnity of new securities to replace the ones lost, and, to the insurance Company under the' provisions of the insurance carried by the Sender. r2Q Depone3nt ' STATE OF SS: F COUNTY OF ti i 19 Albefore me personally appeared the above deponent day of ,f On this f f' to me known and kn wn tome to be the IndWidual 7 .. described In and 'who executed the foregoing agreement, and duly acknowledged that he execut the some and haying been duty sworn, said that the statements therein were true. 4 ' tt y. i, Notary Pupfic Q#te�of ratilart �Of(�Oarttm��p: r�t sa rireN ate` Ott iFara lfl�2 j"iV 424011119ftee►ly427 .IF) pwtgtl t i Otl%4W Xtxlt max` Ti;F Mowryfi x Np, 944OTf -: com f t �t,'�..r<z•.c.,.,,, `.�� :. s .� '`_fie-,