The following documentation is an electronicallysubmitted vendor response to an advertised solicitation from the West Virginia Purchasing Bulletin

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1 The following documentation is an electronicallysubmitted vendor response to an advertised solicitation from the West Virginia Purchasing Bulletin within the Vendor Self Service portal at wvoasis.gov. As part of the State of West Virginia s procurement process, and to maintain the transparency of the bid opening process, this documentation submitted online is publicly posted by the West Virginia Purchasing Division at WVPurchasing.gov with any other vendor responses to this solicitation submitted to the Purchasing Division in hard copy format.

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3 Purchasing Division 2019 Washington Street East Post Office Box Charleston, WV State Of West Virginia Solicitation Response Proc Folder : Solicitation Description : ADDENDUM NO. 2 - BLANKET BONDING FOR LIMITED VIDEO LOTTERY Date issued Proc Type : Central Master Agreement Solicitation Closes Solicitation No Version :30:00 SR 0705 ESR VENDOR SURETY GROUP AGENCY LLC FOR INFORMATION CONTACT THE BUYER Evelyn Melton (304) evelyn.p.melton@wv.gov Signature X FEIN # DATE All offers subject to all terms and conditions contained in this solicitation Page : 1 FORM ID : WV-PRC-SR-001

4 Line Comm Ln Desc Qty Unit Issue Unit Price Ln Total Or Contract Amount 1 COST PER $ 1, OF COVERAGE: NO DEDUCTIBLE UNIT $12.50 Comm Code Manufacturer Specification Model # Extended Description : COST PER $ 1, OF COVERAGE: NO DEDUCTIBLE Line Comm Ln Desc Qty Unit Issue Unit Price Ln Total Or Contract Amount 2 COST PER $ OF COVERAGE: $10, UNIT $11.50 Comm Code Manufacturer Specification Model # Extended Description : COST PER $ 1, OF COVERAGE: $10, DEDUCTIBLE Line Comm Ln Desc Qty Unit Issue Unit Price Ln Total Or Contract Amount 3 COST PER $1, OF COVERAGE: $25, UNIT $10.00 Comm Code Manufacturer Specification Model # Extended Description : COST PER $ 1, OF COVERAGE: $ 25, DEDUCTIBLE Line Comm Ln Desc Qty Unit Issue Unit Price Ln Total Or Contract Amount 4 COST PER $1, OF COVERAGE: $50, UNIT $8.00 Comm Code Manufacturer Specification Model # Extended Description : COST PER $ 1, OF COVERAGE: $ 50, DEDUCTIBLE ADDENDUM NO. 2 IS ISSUED: Page : 2

5 State of West Virginia License No: Agent License NPN: LICENSE TYPE LINES OF AUTHORITY LESLIE A. WORLEY LOA EFFECTIVE DATE LICENSE EXPIRATION DATE PRODUCER Casualty 02/13/ /28/2017 LESLIE A. WORLEY State of West Virginia License No: Agent License NPN: LESLIE A. WORLEY This is to certify that the above named agent is licensed in the State of West Virginia with the following authority(ies): LICENSE TYPE LINE(S) OF AUTHORITY LOA EFFECTIVE DATE LICENSE EXPIRATION DATE PRODUCER Casualty 02/13/ /28/2017 Please visit sbs-wv.naic.org/lion-web/jsp/sbsreports/agentlookup.jsp for the current status of this license.

6 THE SURETY GROUP AGENCY, LLC THE SURETY GROUP AGENCY, LLC LEBANON ROAD MOUNT JULIET TN License No: State of West Virginia Agency License THE SURETY GROUP AGENCY, LLC Doing Business As: THE SURETY GROUP This is to certify that the above named agent is licensed in the State of West Virginia with the following authority(ies): LICENSE TYPE LICENSE EXPIRATION DATE BUSINESS ENTITY 06/30/2015 Please visit sbs-wv.naic.org/lion-web/jsp/sbsreports/agentlookup.jsp for the current status of this license.

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16 12890 Lebanon Road Mount Juliet, TN USA Fax March 6, 2015 Ms. Evelyn Melton State of West Virginia RE: CRFQ 0705 Lot Dear Ms. Melton, The Surety Group Agency, LLC is not an insurance company therefore we do not possess an AM Best rating. We have attached documentation for Great American Insurance Company which is A+ rated by AM Best and will support the bond along with the Surety Group Agency. The Surety Group Agency, LLC believes that we are in compliance with the spirit of the RFQ in regards to the AM Best A+ rated carrier as the bond will be issued and supported by Great American Insurance Company. Should you have any questions or concerns regarding our proposal, please do not hesitate to contact me. Sincerely, Elizabeth Brooks VP of the Surety Group

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