COMMONWEALTH OF KENTUCKY DEPARTMENT FRANKFORT, KENTUCKY 40601 ATTACHMENT TO FORM NO. SI - 03, 1/2004 SURETY RIDER TO BE ATTACHED TO AND FORM A PART OF BOND NUMBER EXECUTED BY , AS PRINCIPAL, AND BY , AS SURETY, IN FAVOR OF THE COMMONWEALTH OF KENTUCKY, DEPARTMENT (INCREASE/DECREASE) THE AMOUNT OF SAID BOND FROM: TO: The Surety agrees that the obligation of this endorsement and the above - referenced bond shall cover and ext end to all past, present, - insured employer, to the sum herein named. Nothing herein contained shall vary, alter or extend any provision or condition of the original b ond except as herein expressly stated. This rider is effective Signed and sealed this day of , 20. PRINCIPAL BY: SURETY BY: American LegalNet, Inc. www.FormsWorkFlow.com