Guarantee Resolution

<document>COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.STATE OF CONNECTICUTJUDICIAL SUBPOENAWORKERS' COMPENSATION COMMISSIONPlaintiff(s) -against-Defendant(s)GUARANTEE RESOLUTIONI, , Secretary of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., a corporation organized and existing under the laws of the State of , DO HEREBY CERTIFY that the following is a true and correct copy of the resolutions duly adopted on by the Corporation's Board of Directors at meeting thereof duly called and held / by written consent action, in accordance with the provisions of the Bylaws of the Corporation.THE PEOPLE OF THE STATE OF NEW YORK TORESOLVED that will guarantee the payment of all workers' compensation liabilities incurred by any of its divisions, subsidiaries or their subsidiaries, as an employer approved to self-insure its workers' compensation liabilities resulting from its operations in the State of Connecticut.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomAND BE IT FURTHER RESOLVED that the Corporation Chairman, President, Vice-President, Treasurer, Assistant Treasurer, Secretary or Chief Financial Officer are severally authorized to sign any forms required to be executed in connection with the aforesaid guarantee.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.AND I DO FURTHER CERTIFY that these resolutions have not been amended, annulled, rescinded or revoked, and that these resolutions are in full force and effect., one of the Justices of theCourt in Witness, Honorableday of, 20 County,SIGNED AND SEALED on behalf of the Corporation this day of , 20.(Attorney must sign above and type name below)[SEAL]Attorney(s) for Secretary-signature Secretary-print nameOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com</document>